Provider Demographics
NPI:1598737579
Name:KNOTT PATTERSON, BEVERLY G (FNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:G
Last Name:KNOTT PATTERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-878-2260
Mailing Address - Fax:336-878-2277
Practice Address - Street 1:501 HICKORY BRANCH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9601
Practice Address - Country:US
Practice Address - Phone:336-878-2260
Practice Address - Fax:336-878-2277
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005735Medicaid
MK0636045OtherFEDERAL DEA
MK0636045OtherFEDERAL DEA
2592311Medicare ID - Type Unspecified
NC7005735Medicaid