Provider Demographics
NPI:1508069071
Name:MCCALLISTER, PATRICIA RINER (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RINER
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W HOBSONWAY STE C
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1651
Mailing Address - Country:US
Mailing Address - Phone:760-922-4981
Mailing Address - Fax:
Practice Address - Street 1:321 W HOBSONWAY STE C
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1651
Practice Address - Country:US
Practice Address - Phone:760-922-4981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4360363LF0000X
ID1371-A363LF0000X
FL2979752363LX0001X
CA95010757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1371-AOtherIDAHO BOARD OF NURSING
FLY9271OtherBCBS
FL301426600Medicaid