Basic Information
| Provider Information | |||||||||
| NPI: | 1578563169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 N WOODLAWN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672202729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166843838 | ||||||||
| FaxNumber: | 3168582521 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 N WOODLAWN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672202729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166843838 | ||||||||
| FaxNumber: | 3168582521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 03/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 44841 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 44841 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 100447630E | 05 | KS | MEDICAID | 100447630D | 05 | KS | MEDICAID | P00606968 | 01 | KS | PALMETTO (RR MC) | OTHER | 100447630H | 05 | KS | MEDICAID |