Individual
KENNETH BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1323 W 6TH AVE, STILLWATER, OK 74074-4306
(405) 372-1480
Mailing address
PO BOX 720006, NORMAN, OK 73070-4006
(405) 372-1480
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
120925
OK
367500000X
Certified Registered Nurse Anesthetist
1380744092
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000145009
BLUE CROSS OF KS
KS
Enumeration date
08/30/2006
Last updated
03/10/2020
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