Provider Demographics
NPI:1912314600
Name:PATTERSON, KATHLEEN R (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1666
Mailing Address - Country:US
Mailing Address - Phone:641-342-2128
Mailing Address - Fax:
Practice Address - Street 1:827 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1666
Practice Address - Country:US
Practice Address - Phone:641-342-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA119591363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01353136OtherRR MEDICARE
IA1912314600Medicaid
IA1912314600Medicaid