Provider Demographics
NPI:1053657114
Name:PATE, JILL CHRISTINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CHRISTINE
Last Name:PATE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 S PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4916
Mailing Address - Country:US
Mailing Address - Phone:409-384-5701
Mailing Address - Fax:409-384-4238
Practice Address - Street 1:1276 S PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4916
Practice Address - Country:US
Practice Address - Phone:409-384-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily