Provider Demographics
NPI:1538187158
Name:PATE, DAVID A (CRNP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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:PO BOX 2145
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-2145
Mailing Address - Country:US
Mailing Address - Phone:334-321-3700
Mailing Address - Fax:334-887-7475
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:33830-6471
Practice Address - Country:US
Practice Address - Phone:334-321-3700
Practice Address - Fax:334-887-7475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-045071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504239OtherBLUE CROSS BLUE SHIELD
AL051504239OtherBLUE CROSS BLUE SHIELD
ALP28888Medicare UPIN