Jessie Nicole Bates

Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Starkville, MS

NPI 1861065716 · NPPES record last updated Jul 19, 2021

Key facts

NPI
1861065716
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
License
E-100211 (MS)
Practice address
826 Highway 12 W
Starkville, MS 39759-3582
Phone
(662) 324-8053
NPI assigned
Jul 19, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
E-100211MSMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Limited Partnership I Past
since Jul 25, 2021
Accepting new patients
Kroger Limited Partnership I Past
since Jul 25, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X E-100211 MS Yes

Addresses

Primary practice location

826 Highway 12 W
Starkville, MS 39759-3582

Mailing address

826 Highway 12 W
Starkville, MS 39759-3582

Other providers in Starkville, MS

All providers in Starkville, MS · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Mississippi

Sources for this page

Verify at the official NPI Registry.