Provider Demographics
NPI:1134541857
Name:PADGETT, PATRICIA ILENE (BS)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ILENE
Last Name:PADGETT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ILENE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:154 W SHADY LN
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-4005
Mailing Address - Country:US
Mailing Address - Phone:580-279-9591
Mailing Address - Fax:580-889-3887
Practice Address - Street 1:1410 S. GIN RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525
Practice Address - Country:US
Practice Address - Phone:580-889-3399
Practice Address - Fax:580-889-3887
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health