Provider Demographics
NPI:1730120353
Name:PATTON, JENNIFER MITCHELL (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MITCHELL
Last Name:PATTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:596 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-7818
Mailing Address - Country:US
Mailing Address - Phone:864-876-5456
Mailing Address - Fax:864-876-5456
Practice Address - Street 1:100 E WOOD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3004
Practice Address - Country:US
Practice Address - Phone:864-583-1222
Practice Address - Fax:864-582-5154
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN617367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered