Provider Demographics
NPI:1225117617
Name:PATTON, MARY C (PA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:PATTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:990 S GEORGE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3900
Mailing Address - Country:US
Mailing Address - Phone:316-686-2111
Mailing Address - Fax:316-686-3659
Practice Address - Street 1:990 S GEORGE WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3900
Practice Address - Country:US
Practice Address - Phone:316-686-2111
Practice Address - Fax:316-686-3659
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant