Provider Demographics
NPI:1326386756
Name:PATTERSON, AHNA ALISIA (PA-C)
Entity Type:Individual
Prefix:
First Name:AHNA
Middle Name:ALISIA
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 BROADWAY AVE
Mailing Address - Street 2:APT 10305
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7535
Mailing Address - Country:US
Mailing Address - Phone:504-239-9112
Mailing Address - Fax:
Practice Address - Street 1:3751 S I-35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6852
Practice Address - Country:US
Practice Address - Phone:940-383-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA08289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant