Basic Information
| Provider Information | |||||||||
| NPI: | 1780112227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATE | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 E 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310151514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292738881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 510 ALSTON ST | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318256012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2298873324 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2017 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN216671 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.