Provider Demographics
NPI:1275934317
Name:PATTERSON, TERISSA
Entity Type:Individual
Prefix:
First Name:TERISSA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GOLDEN BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-2714
Mailing Address - Country:US
Mailing Address - Phone:253-219-8656
Mailing Address - Fax:
Practice Address - Street 1:51 GOLDEN BIRCH DR
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315-2714
Practice Address - Country:US
Practice Address - Phone:253-219-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002056078164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse