Provider Demographics
NPI:1144616962
Name:PATTERSON, JENNIFER J (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:20053 SUMMIT VIEW BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-755-2560
Mailing Address - Fax:315-755-2597
Practice Address - Street 1:20053 SUMMIT VIEW BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-755-2560
Practice Address - Fax:315-755-2597
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307265363LA2200X
NYF307265-01363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
13541620OtherCAQH
NY04155946Medicaid