MEDICARE: JANETT M PATE NP

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	15691	TN
2	363LF0000X	Family Nurse Practitioner	0024170885	VA

General Provider Information

NPI Number	:	1952609463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANETT M PATE NP

Provider Business Mailing Address
First Line	:	105 W STONE DR
Second Line	:	SUITE 6A
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3365
Country	:	US
Telephone Number	:	423-408-7220
Fax Number	:	423-408-7405

Provider Business Practice Location Address
First Line	:	109 MEADOW VIEW RD
Second Line	:	SUITE 3
City	:	BRISTOL
State	:	TN
Zip	:	37620-1661
Country	:	US
Telephone Number	:	423-968-2446
Fax Number	:	423-968-7223

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

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	07/17/2013

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