Provider Demographics
NPI:1831293497
Name:VERHULST, PATRICIA L (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:VERHULST
Suffix:
Gender:F
Credentials:MD
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 5000
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-5000
Mailing Address - Country:US
Mailing Address - Phone:615-444-2320
Mailing Address - Fax:615-449-3163
Practice Address - Street 1:2831 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5002
Practice Address - Country:US
Practice Address - Phone:931-245-8600
Practice Address - Fax:931-245-8660
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY341112085R0202X
TN427022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000696946OtherBCBS
KY64341118Medicaid
TN3000647Medicaid
KYP00915988OtherRR MEDICARE
KY0046115Medicare ID - Type Unspecified
TN3000647Medicare PIN
KY000000696946OtherBCBS
TN3000647Medicaid
KYP00915988OtherRR MEDICARE
KYP400037020Medicare PIN
KYP400037022Medicare PIN
KYP400037024Medicare PIN