Provider Demographics
NPI:1669048211
Name:PATTERSON, CEREASA LEEANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CEREASA
Middle Name:LEEANN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CEREASA
Other - Middle Name:LEEANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 N WACO ST STE 220
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1102
Mailing Address - Country:US
Mailing Address - Phone:316-722-2138
Mailing Address - Fax:833-464-2530
Practice Address - Street 1:7701 E KELLOGG DR STE 490
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1716
Practice Address - Country:US
Practice Address - Phone:316-722-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80521-032363LF0000X
KS13-134071-032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse