Provider Demographics
NPI:1881802585
Name:CONTINA MCCLAIN PATTON ARNP PLLC
Entity type:Organization
Organization Name:CONTINA MCCLAIN PATTON ARNP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLAIN-PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-409-5088
Mailing Address - Street 1:5407 GALAXIE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3329
Mailing Address - Country:US
Mailing Address - Phone:502-299-1827
Mailing Address - Fax:
Practice Address - Street 1:1512 CRUMS LN., STE 305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-409-5088
Practice Address - Fax:502-409-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4354P363LA2200X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4354POtherARNP LISENCE NUMBER
KY4354POtherARNP LISENCE NUMBER