Provider Demographics
NPI:1336417468
Name:PATTON, FELICIA NATASHA (BA)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:NATASHA
Last Name:PATTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COUNTRY BIRCH CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-6666
Mailing Address - Country:US
Mailing Address - Phone:901-336-7073
Mailing Address - Fax:
Practice Address - Street 1:4000 COUNTRY BIRCH CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-6666
Practice Address - Country:US
Practice Address - Phone:901-336-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN096615868103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst