Provider Demographics
NPI:1376754101
Name:PATEY, KIM MARIE (AP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:PATEY
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:PATEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:PO BOX 46457
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0104
Mailing Address - Country:US
Mailing Address - Phone:813-300-8585
Mailing Address - Fax:954-389-1400
Practice Address - Street 1:8903 REGENTS PARK DR
Practice Address - Street 2:SUITE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3083
Practice Address - Country:US
Practice Address - Phone:813-960-8833
Practice Address - Fax:954-389-1400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist