Provider Demographics
NPI:1659903615
Name:PATTON, CAREN STEPHINE (MSN, FPMHNP)
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:STEPHINE
Last Name:PATTON
Suffix:
Gender:F
Credentials:MSN, FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:
Practice Address - Street 1:612 E ELM ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1552
Practice Address - Country:US
Practice Address - Phone:417-761-5511
Practice Address - Fax:417-761-5512
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015533163W00000X
MO2020007037363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse