Provider Demographics
NPI:1457303653
Name:PATTON, KERRI L (NPC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:PATTON
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:L
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:POWELL 206
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-5100
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:POWELL 206
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF0206129363LF0000X
IAA-129494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1457303653Medicaid
IAP01353486OtherRR MEDICARE
IA719260489Medicare PIN
IA1457303653Medicaid