Provider Demographics
NPI:1841234879
Name:BADER, PATRICIA W (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:BADER
Suffix:
Gender:F
Credentials:NP
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 188
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-0188
Mailing Address - Country:US
Mailing Address - Phone:901-481-3922
Mailing Address - Fax:901-465-8177
Practice Address - Street 1:3109 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3509
Practice Address - Country:US
Practice Address - Phone:901-481-3922
Practice Address - Fax:901-465-8177
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 5452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348196Medicaid
4120690OtherBLUE CROSS BLUE SHIELD
P00287480OtherRAILROAD MEDICARE
TN3348196Medicaid
TN3348196Medicare PIN