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General NPI Number Information
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NPI Number | 1275161358
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Entity Type | Individual
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Provider Name | KATHERINE LYNN PATE PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 5005 PORT ST JOHN PKWY STE 2200
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City | PORT ST JOHN
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State | FL
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Zip | 32927-4305
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Country | US
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Telephone | 321-433-2247
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Fax | 803-936-8097
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Provider Business Mailing Address
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Address Line | 4945 BRIDGE RD
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City | COCOA
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State | FL
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Zip | 32927-9105
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Country | US
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Telephone | 208-651-4933
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4461
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9118332
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License Number State | FL
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