Provider Demographics
NPI:1518443225
Name:PATTEN, KEITH MARTIN (FNP)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MARTIN
Last Name:PATTEN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-2810
Mailing Address - Fax:314-454-2818
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE 4E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2810
Practice Address - Fax:314-454-2818
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024330363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420060116Medicaid
MO420060116Medicaid