Provider Demographics
NPI:1972048304
Name:PATE, JENNIFER W (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:PATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:W
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 LAKELAND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7640
Mailing Address - Country:US
Mailing Address - Phone:601-326-2599
Mailing Address - Fax:
Practice Address - Street 1:2506 LAKELAND DR STE 300
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7640
Practice Address - Country:US
Practice Address - Phone:601-326-2599
Practice Address - Fax:601-933-0852
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901879363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care