Provider Demographics
NPI:1609399450
Name:PATE, RUBY RUNEE (DNP)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:RUNEE
Last Name:PATE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432057 STATE HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:FORT TOWSON
Mailing Address - State:OK
Mailing Address - Zip Code:74735-7506
Mailing Address - Country:US
Mailing Address - Phone:580-372-6571
Mailing Address - Fax:
Practice Address - Street 1:1402 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2059
Practice Address - Country:US
Practice Address - Phone:580-372-6571
Practice Address - Fax:855-710-6431
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139007363LF0000X
OK106368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily