Provider Demographics
NPI:1336550508
Name:PATTERSON, JOHNNY EDWARD JR (APN)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:EDWARD
Last Name:PATTERSON
Suffix:JR
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 SOUTH BUTLER ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GRETNA
Mailing Address - State:PA
Mailing Address - Zip Code:17064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 BUTLER RD
Practice Address - Street 2:
Practice Address - City:MOUNT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064-6085
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000126363LP0808X
PASP013760363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health