Provider Demographics
NPI:1861660870
Name:PATTERSON, KATHRYN A (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:PATTERSON
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 1:640 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897-3402
Mailing Address - Country:US
Mailing Address - Phone:417-837-2270
Mailing Address - Fax:417-837-2271
Practice Address - Street 1:640 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-2203
Practice Address - Country:US
Practice Address - Phone:417-837-2270
Practice Address - Fax:417-837-2271
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO098170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00724812OtherRAILROAD MEDICARE
MO1861660870Medicaid
431560263OtherTRICARE WEST
AR177818758Medicaid
AR177818758Medicaid