Provider Demographics
NPI:1093148629
Name:PATTERSON, LATONYA DESHON (PMHNP-BC, MSN/ED)
Entity type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:DESHON
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN/ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 KUMQUAT RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33413-1117
Mailing Address - Country:US
Mailing Address - Phone:561-970-9779
Mailing Address - Fax:
Practice Address - Street 1:2393 S CONGRESS AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7628
Practice Address - Country:US
Practice Address - Phone:561-285-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023001721363LP0808X
AR223494363LP0808X
FL11031059363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420119436Medicaid
AR298419758Medicaid