Provider Demographics
NPI:1740524941
Name:PATTON, JACKIE R (RN)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:R
Last Name:PATTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-1127
Mailing Address - Country:US
Mailing Address - Phone:740-856-9788
Mailing Address - Fax:740-767-2959
Practice Address - Street 1:29 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOUSTER
Practice Address - State:OH
Practice Address - Zip Code:45732-1127
Practice Address - Country:US
Practice Address - Phone:740-856-9788
Practice Address - Fax:740-767-2959
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 168364163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse