Provider Demographics
NPI:1952972606
Name:PATTERSON, KIMBERLY DARNELL (PMHNP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DARNELL
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 CLARKE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-3502
Mailing Address - Country:US
Mailing Address - Phone:901-691-2773
Mailing Address - Fax:
Practice Address - Street 1:5652 CLARKE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3502
Practice Address - Country:US
Practice Address - Phone:901-729-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29794363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0Medicaid