Individual
ANN FATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
520 DOUGLAS BLVD, TYLER, TX 75702-8307
(903) 593-1721
Mailing address
PO BOX 840698, DALLAS, TX 75284-0698
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP124442
TX
363LP2300X
Primary Care Nurse Practitioner
661964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330328101
—
TX
05
—
330328102
—
TX
01
—
75-2616977-007
TRICARE
TX
01
—
772093
MEDICARE
TX
01
—
8066NF
BCBS BLUE
TX
01
—
P01290912
RAIL ROAD
TX
Enumeration date
11/06/2013
Last updated
05/28/2019
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