Provider Demographics
NPI:1295516698
Name:PATRICK, NAVEED
Entity type:Individual
Prefix:
First Name:NAVEED
Middle Name:
Last Name:PATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N BURR OAK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2105
Mailing Address - Country:US
Mailing Address - Phone:316-806-9645
Mailing Address - Fax:316-867-2573
Practice Address - Street 1:223 N BURR OAK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2105
Practice Address - Country:US
Practice Address - Phone:316-806-9645
Practice Address - Fax:316-867-2573
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087196311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home