Provider Demographics
NPI:1659779809
Name:PATTERSON, MONEKA ANGILENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MONEKA
Middle Name:ANGILENE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 BLAIR CIR NE UNIT 4210
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2266
Mailing Address - Country:US
Mailing Address - Phone:843-617-3028
Mailing Address - Fax:
Practice Address - Street 1:3637 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1252
Practice Address - Country:US
Practice Address - Phone:404-926-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269126363LF0000X
SC19215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3147Medicaid
SCNP3147Medicaid
SCSC55811850Medicare PIN