Provider Demographics
NPI:1124208533
Name:TREVER PATTON, PA
Entity Type:Organization
Organization Name:TREVER PATTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-636-1188
Mailing Address - Street 1:7807 E FUNSTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3123
Mailing Address - Country:US
Mailing Address - Phone:316-636-1188
Mailing Address - Fax:316-636-1190
Practice Address - Street 1:7807 E FUNSTON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3123
Practice Address - Country:US
Practice Address - Phone:316-636-1188
Practice Address - Fax:316-636-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1013952134OtherINDIVIDUAL NPI
IDN6300OtherBLUE CROSS
ID16849372OtherMEDICARE GROUP PIN
ID000010160661OtherBLUE SHIELD
ID000010160661OtherBLUE SHIELD
ID16849372OtherMEDICARE GROUP PIN