Provider Demographics
NPI:1295100162
Name:PATTERSON, KATHERINE
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
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 1:2124 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 303B
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7264
Mailing Address - Country:US
Mailing Address - Phone:540-602-7619
Mailing Address - Fax:540-602-7908
Practice Address - Street 1:2124 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 303B
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7264
Practice Address - Country:US
Practice Address - Phone:540-602-7619
Practice Address - Fax:540-602-7908
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67318077172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver