Provider Demographics
NPI:1295775765
Name:PATTON, KATHLEEN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:PATTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3206 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5143
Mailing Address - Country:US
Mailing Address - Phone:903-663-7393
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:6901 MEDICAL PKWY
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7910
Practice Address - Country:US
Practice Address - Phone:254-751-4299
Practice Address - Fax:903-663-7394
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM76472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194501602Medicaid
TX8BE940OtherBLUE CROSS BLUE SHIELD
TX194501601Medicaid
TX8K8392Medicare PIN
TX8K8153Medicare PIN
TXI59972Medicare UPIN