Provider Demographics
NPI:1225257751
Name:MANEY, PATRICIA A (CPNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MANEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 N HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1505
Mailing Address - Country:US
Mailing Address - Phone:478-922-9001
Mailing Address - Fax:478-329-8619
Practice Address - Street 1:1049 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1505
Practice Address - Country:US
Practice Address - Phone:478-922-9001
Practice Address - Fax:478-329-8619
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN095059363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00867347AMedicaid