Provider Demographics
NPI:1619065562
Name:PATTON, ANN M (CFNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:PATTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:294 COUNTY RD 1130
Mailing Address - Street 2:
Mailing Address - City:COOPER
Mailing Address - State:TX
Mailing Address - Zip Code:75432
Mailing Address - Country:US
Mailing Address - Phone:903-395-2091
Mailing Address - Fax:
Practice Address - Street 1:181 E DALLAS AVE
Practice Address - Street 2:
Practice Address - City:COOPER
Practice Address - State:TX
Practice Address - Zip Code:75432
Practice Address - Country:US
Practice Address - Phone:903-395-2192
Practice Address - Fax:903-395-2193
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S11409Medicare UPIN