Provider Demographics
NPI:1558127001
Name:NORTHAM, PATRICK ALLEN (PA-STUDENT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALLEN
Last Name:NORTHAM
Suffix:
Gender:M
Credentials:PA-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21523 PADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-2753
Mailing Address - Country:US
Mailing Address - Phone:828-403-9506
Mailing Address - Fax:
Practice Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-239-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program