Provider Demographics
NPI:1225832884
Name:TATE, KORKI S (NP)
Entity type:Individual
Prefix:
First Name:KORKI
Middle Name:S
Last Name:TATE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MERT RICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-7316
Mailing Address - Country:US
Mailing Address - Phone:662-574-6136
Mailing Address - Fax:
Practice Address - Street 1:140 MERT RICKMAN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-7316
Practice Address - Country:US
Practice Address - Phone:662-574-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS875952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse