Individual
ALICIA PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3900 ST FRANCIS WAY STE 201, LAFAYETTE, IN 47905-4923
(765) 446-7981
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085002324
IL
363AM0700X
Medical Physician Assistant
10001351A
IN
363AS0400X
Surgical Physician Assistant
08502324
IL
363AS0400X
Surgical Physician Assistant
Primary
10001351A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000741060
ANTHEM PROVIDER NUMBER
IN
01
—
085002324
LICENSE
IL
01
—
2005016213
LICENSE
MO
Enumeration date
06/30/2005
Last updated
12/02/2014
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