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General NPI Number Information
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NPI Number | 1093101917
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Entity Type | Individual
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Provider Name | LEIGH PATE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 110 E DEKALB ST STE C
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City | CAMDEN
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State | SC
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Zip | 29020-4432
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Country | US
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Telephone | 803-713-0806
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Fax |
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Provider Business Mailing Address
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Address Line | 2433 HANGING ROCK RD
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City | KERSHAW
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State | SC
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Zip | 29067-8133
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Country | US
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Telephone | 803-804-0654
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19356
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License Number State | SC
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