Provider Demographics
NPI:1285221366
Name:PATTERSON, KAITLYN KENNEDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:KENNEDY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 11
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8213
Mailing Address - Country:US
Mailing Address - Phone:229-256-2411
Mailing Address - Fax:229-256-2488
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 11
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8213
Practice Address - Country:US
Practice Address - Phone:229-256-2411
Practice Address - Fax:229-256-2488
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029672OtherPHARMACIST LICENSE