Provider Demographics
NPI:1093460099
Name:PATE, EVA DANNIELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:DANNIELLE
Last Name:PATE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2403
Mailing Address - Country:US
Mailing Address - Phone:601-509-9064
Mailing Address - Fax:
Practice Address - Street 1:5135 US-84
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443
Practice Address - Country:US
Practice Address - Phone:601-340-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily