Provider Demographics
NPI:1619433125
Name:PATTERSON, KACEY ALEXANDRA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KACEY
Middle Name:ALEXANDRA
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:ALEXANDRA
Other - Last Name:LANGENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4219 LACLEDE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2814
Mailing Address - Country:US
Mailing Address - Phone:314-286-4545
Mailing Address - Fax:
Practice Address - Street 1:4219 LACLEDE AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2814
Practice Address - Country:US
Practice Address - Phone:314-286-4545
Practice Address - Fax:314-286-4542
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018088779363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health