Provider Demographics
NPI:1922614171
Name:TATE, KATHLEEN MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MICHELE
Last Name:TATE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:STE 1460
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4621
Mailing Address - Country:US
Mailing Address - Phone:601-982-3202
Mailing Address - Fax:601-982-3259
Practice Address - Street 1:2412 MEADOW OAK
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8780
Practice Address - Country:US
Practice Address - Phone:601-986-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MS904614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program