Provider Demographics
NPI:1841961257
Name:PATTERSON, MISTY RENEE (NP-C)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:RENEE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5566
Mailing Address - Country:US
Mailing Address - Phone:515-574-6800
Mailing Address - Fax:
Practice Address - Street 1:800 KENYON RD STE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5776
Practice Address - Country:US
Practice Address - Phone:515-574-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily