Provider Demographics
NPI:1336189471
Name:PATE, PAM (FNP, PNP)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:FNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 EDUCATORS LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8191
Mailing Address - Country:US
Mailing Address - Phone:901-384-9920
Mailing Address - Fax:901-937-7879
Practice Address - Street 1:7865 EDUCATORS LANE
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8191
Practice Address - Country:US
Practice Address - Phone:901-226-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08623073Medicaid
TNS38890Medicare UPIN
TN3902039Medicare PIN