Provider Demographics
NPI:1760849756
Name:TATE, JESSIE (CRNA)
Entity Type:Individual
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First Name:JESSIE
Middle Name:
Last Name:TATE
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:8080 E CENTRAL AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2368
Mailing Address - Country:US
Mailing Address - Phone:316-686-7327
Mailing Address - Fax:316-686-1557
Practice Address - Street 1:8080 E CENTRAL AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2368
Practice Address - Country:US
Practice Address - Phone:316-686-7327
Practice Address - Fax:316-686-1557
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CORN0189836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered