Provider Demographics
NPI:1568182756
Name:PATE, AINSLEY GRACE
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:GRACE
Last Name:PATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24261 SE BOHNA PARK RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-9304
Mailing Address - Country:US
Mailing Address - Phone:504-560-4576
Mailing Address - Fax:
Practice Address - Street 1:3600 N. GARFIELD
Practice Address - Street 2:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:503-560-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program