Provider Demographics
NPI:1619997285
Name:MCCLAIN-PATTON, CONTINA A (ARNP)
Entity Type:Individual
Prefix:
First Name:CONTINA
Middle Name:A
Last Name:MCCLAIN-PATTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 GALAXIE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3329
Mailing Address - Country:US
Mailing Address - Phone:502-299-1827
Mailing Address - Fax:
Practice Address - Street 1:1512 CRUMS LN STE 305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3869
Practice Address - Country:US
Practice Address - Phone:502-409-5088
Practice Address - Fax:502-409-5092
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4354P363L00000X
KY3004354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYQ58092Medicare UPIN