| NPI | 1023482106 |
|---|---|
| Former Name | TIFFANY SUSAN PATE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: KY 3009839) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009839) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2022-04-19 |