Provider Demographics
NPI:1124180435
Name:MCDADE JENKINS, PATRICIA A (MSN, RN,FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:MCDADE JENKINS
Suffix:
Gender:F
Credentials:MSN, RN,FNP-BC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:MCDADE JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VERIFY SECURITY QUE
Mailing Address - Street 1:3628 PERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1410
Mailing Address - Country:US
Mailing Address - Phone:314-258-6041
Mailing Address - Fax:
Practice Address - Street 1:3628 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1410
Practice Address - Country:US
Practice Address - Phone:314-258-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO075505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000080977Medicare ID - Type Unspecified