Healthcare Provider Details

I. General information

NPI: 1730453622
Provider Name (Legal Business Name): BRIANNA CAROL PATE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 MEDICAL CENTER PARKWAY
CLINTON AR
72031-1529
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-7888
  • Fax: 501-745-4401
Mailing address:
  • Phone: 870-448-5101
  • Fax: 870-448-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03641
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: