Provider Demographics
NPI:1003497876
Name:PATEL, SUMITRA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SUMITRA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28555 BOYDS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-3454
Mailing Address - Country:US
Mailing Address - Phone:256-566-5543
Mailing Address - Fax:
Practice Address - Street 1:1002 BRINDLEY DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4705
Practice Address - Country:US
Practice Address - Phone:931-363-5438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121908363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health