Provider Demographics
NPI:1740242395
Name:PATCH, KATHY B (MS CS ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:B
Last Name:PATCH
Suffix:
Gender:F
Credentials:MS CS ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 GOVERNORS RD
Mailing Address - Street 2:SHORTRIDGE ACADEMY
Mailing Address - City:MILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03851
Mailing Address - Country:US
Mailing Address - Phone:603-755-3096
Mailing Address - Fax:603-755-9096
Practice Address - Street 1:619 GOVERNORS RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NH
Practice Address - Zip Code:03851-4757
Practice Address - Country:US
Practice Address - Phone:603-755-3096
Practice Address - Fax:603-755-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0375452308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2106159OtherCIGNA
NH30422106Medicaid
40Y000871NH01OtherBCBS NH
40Y000871NH01OtherBCBS NH
P17354Medicare UPIN