Provider Demographics
NPI:1952609463
Name:PATE, JANETT M (NP)
Entity type:Individual
Prefix:
First Name:JANETT
Middle Name:M
Last Name:PATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:109 MEADOW VIEW RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1661
Practice Address - Country:US
Practice Address - Phone:423-968-2446
Practice Address - Fax:423-968-7223
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2013-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN15691363LF0000X
VA0024170885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I2855Medicare PIN
TN103I501346Medicare PIN
VAVV9903BMedicare PIN