Provider Demographics
NPI:1255174967
Name:PATEL, PAYAL (PA-C)
Entity type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1266 E POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1945
Mailing Address - Country:US
Mailing Address - Phone:731-439-6746
Mailing Address - Fax:
Practice Address - Street 1:1574 MEDICAL CENTER PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3761
Practice Address - Country:US
Practice Address - Phone:615-225-2070
Practice Address - Fax:615-962-9047
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN6045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant