Provider Demographics
NPI:1437265006
Name:PATIK, TONI S (PA-C)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:S
Last Name:PATIK
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 1:6501 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4293
Mailing Address - Country:US
Mailing Address - Phone:307-233-4717
Mailing Address - Fax:307-233-4701
Practice Address - Street 1:6501 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4293
Practice Address - Country:US
Practice Address - Phone:307-235-5433
Practice Address - Fax:307-233-4700
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYNPI 1437265006Medicaid
WYW24197Medicare PIN