Provider Demographics
NPI:1538132683
Name:GERKEN, PATTY L (ANP-BC, AOCN)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:L
Last Name:GERKEN
Suffix:
Gender:F
Credentials:ANP-BC, AOCN
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:L
Other - Last Name:LASSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 E SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-1552
Mailing Address - Country:US
Mailing Address - Phone:913-638-6768
Mailing Address - Fax:
Practice Address - Street 1:115 E SPRING AVE
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-1552
Practice Address - Country:US
Practice Address - Phone:913-638-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45611363LA2200X
MO118243363LA2200X
KS13-31356-042163W00000X
MO118213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538132683Medicaid
MO1538132683Medicaid
KSP00953197Medicare PIN
KSK40000063Medicare PIN
KS200003760CMedicaid