Provider Demographics
NPI:1093290629
Name:PATTERSON, JEXANDRIA DOMINIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:JEXANDRIA
Middle Name:DOMINIQUE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:PROF
Other - First Name:JEXANDRIA
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 55255
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-5255
Mailing Address - Country:US
Mailing Address - Phone:404-947-1723
Mailing Address - Fax:305-466-9989
Practice Address - Street 1:144 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2307
Practice Address - Country:US
Practice Address - Phone:404-947-1723
Practice Address - Fax:404-947-1723
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily