Provider Demographics
NPI:1659645851
Name:PATTERSON, STORMY M
Entity type:Individual
Prefix:
First Name:STORMY
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
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 62
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74727-0062
Mailing Address - Country:US
Mailing Address - Phone:580-209-2153
Mailing Address - Fax:
Practice Address - Street 1:1105 LYNNWOOD ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2919
Practice Address - Country:US
Practice Address - Phone:580-924-6263
Practice Address - Fax:580-924-6775
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator