Provider Demographics
NPI:1760229488
Name:PATE, THADDEUS LEE (CRNP)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:LEE
Last Name:PATE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 JACK WARNER PKWY NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-1060
Mailing Address - Country:US
Mailing Address - Phone:205-462-4500
Mailing Address - Fax:205-556-1198
Practice Address - Street 1:1301 JACK WARNER PKWY NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-1060
Practice Address - Country:US
Practice Address - Phone:205-462-4500
Practice Address - Fax:205-556-1198
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106766363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health