Provider Demographics
NPI:1447323233
Name:BATES, JAMES BRADLEY (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:BATES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THIRD STREET, NORTHEAST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273
Mailing Address - Country:US
Mailing Address - Phone:276-679-9100
Mailing Address - Fax:276-679-1926
Practice Address - Street 1:9781 PINE COVE RD
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4435
Practice Address - Country:US
Practice Address - Phone:276-328-6843
Practice Address - Fax:276-328-6843
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24164383367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014784W82Medicare PIN
VAP00426222Medicare PIN