Basic Information
| Provider Information | |||||||||
| NPI: | 1043383607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DARE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | KEHINDE | ||||||||
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| Credential: | APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7738 BAR HARBOR DR | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302963357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785491070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 450 WINN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042940499 | ||||||||
| FaxNumber: | 4042940793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN106769 | GA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | RN106769 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.