Basic Information
| Provider Information | |||||||||
| NPI: | 1982635215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARPE-BATES | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 WHITTINGTON PKWY | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402224928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026255584 | ||||||||
| FaxNumber: | 5024262264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1808A | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 74018086 | 05 | KY | MEDICAID |