Provider Demographics
NPI:1033460019
Name:PATTERSON, LATISHA DARSHA (PA-C)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:DARSHA
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2932
Mailing Address - Country:US
Mailing Address - Phone:252-430-0666
Mailing Address - Fax:252-430-7503
Practice Address - Street 1:381 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2932
Practice Address - Country:US
Practice Address - Phone:252-430-0666
Practice Address - Fax:252-430-7503
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-03750OtherNC MEDICAL BOARD