MEDICARE: ANGELA MARIE PATE

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	363LF0000X	Family Nurse Practitioner	1-085993	AL

General Provider Information

NPI Number	:	1386336493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE PATE

Provider Business Mailing Address
First Line	:	1450 HOLIDAY DR
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0608
Country	:	US
Telephone Number	:	256-617-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-7907
Country	:	US
Telephone Number	:	256-442-4141
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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Directions to “ ANGELA MARIE PATE ” Practice Location

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