Provider Demographics
NPI:1356407548
Name:PATRICK, KARLEEN ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KARLEEN
Middle Name:ANN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-0034
Mailing Address - Country:US
Mailing Address - Phone:360-468-3726
Mailing Address - Fax:
Practice Address - Street 1:406 S 1ST ST
Practice Address - Street 2:SUITE 307
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3801
Practice Address - Country:US
Practice Address - Phone:369-336-3416
Practice Address - Fax:360-336-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001232163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623018Medicaid