Provider Demographics
NPI:1336922913
Name:PATE, KELLI LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:PATE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 CHAMBERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1403
Mailing Address - Country:US
Mailing Address - Phone:607-734-2264
Mailing Address - Fax:607-796-5849
Practice Address - Street 1:3344 CHAMBERS RD STE 100
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1403
Practice Address - Country:US
Practice Address - Phone:607-973-8576
Practice Address - Fax:607-796-5849
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338888164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse