Provider Demographics
NPI:1689042954
Name:PATRICK, JEAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD.
Mailing Address - Street 2:STE. 1810
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6201
Mailing Address - Country:US
Mailing Address - Phone:816-671-4818
Mailing Address - Fax:816-671-4828
Practice Address - Street 1:901 HEARTLAND RD.
Practice Address - Street 2:STE. 1810
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6201
Practice Address - Country:US
Practice Address - Phone:816-671-4818
Practice Address - Fax:816-671-4828
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily