1134217003 NPI number — MRS. PAMELA GAIL TATE B.S.N., C.R.N.P.

Table of content: CECILIA SMITH LCMHC (NPI 1366942559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134217003 NPI number — MRS. PAMELA GAIL TATE B.S.N., C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
PAMELA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.S.N., C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TATE
Provider Other First Name:
PAMELA
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134217003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35631-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-764-7888
Provider Business Mailing Address Fax Number:
256-760-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 TITAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-1197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-764-7888
Provider Business Practice Location Address Fax Number:
256-760-1020
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  1-033395 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181855 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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