Provider Demographics
NPI:1497221444
Name:PATTERSON, KELLY (HEALTH CARE AGENGY)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:HEALTH CARE AGENGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NE 7TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2225
Mailing Address - Country:US
Mailing Address - Phone:305-986-8826
Mailing Address - Fax:
Practice Address - Street 1:14901 NE 7TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2225
Practice Address - Country:US
Practice Address - Phone:305-986-8826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230792374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000441900Medicaid