Provider Demographics
NPI:1770555658
Name:PATTERSON, KATHRYN L (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 RIVERSIDE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4622
Mailing Address - Country:US
Mailing Address - Phone:970-926-8321
Mailing Address - Fax:
Practice Address - Street 1:648 RIVERSIDE DR APT 304
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4622
Practice Address - Country:US
Practice Address - Phone:970-926-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240154207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00323584OtherRAILROAD MEDICARE
VA010290350Medicaid
VA010290350Medicaid
VA010515E87Medicare PIN
VA0221430001Medicare NSC