Provider Demographics
NPI:1326412032
Name:ROUNTREE, PATRICIA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEIGH
Last Name:ROUNTREE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:SEAY
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:511 BRANTLEY ST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1702
Mailing Address - Country:US
Mailing Address - Phone:334-493-3240
Mailing Address - Fax:334-493-9535
Practice Address - Street 1:802 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1632
Practice Address - Country:US
Practice Address - Phone:334-493-3240
Practice Address - Fax:334-493-9535
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
511-71246OtherBLUECROSS BLUESHIELD OF ALABAMA
AL181577Medicaid
101I502108Medicare PIN