Provider Demographics
NPI:1124677521
Name:PATTERSON, KISHA M
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24121 Q4 RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8416
Mailing Address - Country:US
Mailing Address - Phone:785-317-7121
Mailing Address - Fax:
Practice Address - Street 1:3405 NW HUNTERS RIDGE TER
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2509
Practice Address - Country:US
Practice Address - Phone:785-246-3733
Practice Address - Fax:785-246-3406
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78956-092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily