MEDICARE: KELLY H TATE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	201324	NC
2	363LF0000X	Family Nurse Practitioner	201324	NC

General Provider Information

NPI Number	:	1447212378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY H TATE FNP

Provider Business Mailing Address
First Line	:	199 EB TATE RD
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27217-9597
Country	:	US
Telephone Number	:	336-504-0538
Fax Number	:

Provider Business Practice Location Address
First Line	:	3866 RURAL RETREAT RD STE 104
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8462
Country	:	US
Telephone Number	:	336-890-4160
Fax Number	:	336-890-4164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/13/2026

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