Provider Demographics
NPI:1235553611
Name:PATTERSON, KIMBERLE S (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLE
Middle Name:S
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-802-5555
Mailing Address - Fax:479-876-2829
Practice Address - Street 1:1 MERCY WAY STE 20
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3000
Practice Address - Country:US
Practice Address - Phone:479-802-5555
Practice Address - Fax:479-876-2829
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014003649363LF0000X
AR124060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily