Provider Demographics
NPI:1689334112
Name:PATRONIS, KATHERINE ALEXANDRA (LAC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALEXANDRA
Last Name:PATRONIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:HAYNEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36040-0095
Mailing Address - Country:US
Mailing Address - Phone:850-685-6801
Mailing Address - Fax:
Practice Address - Street 1:1219 17TH AVE S STE 8
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2843
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
848286OtherNCCAOM