Provider Demographics
NPI:1154811693
Name:PATTERSON, KIMBERLY SHANNEL (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHANNEL
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 1:109 MAYNARD AVENUE
Mailing Address - Street 2:PO BOX 17
Mailing Address - City:ANSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28007
Mailing Address - Country:US
Mailing Address - Phone:704-695-5561
Mailing Address - Fax:
Practice Address - Street 1:418 S KING ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3704
Practice Address - Country:US
Practice Address - Phone:910-276-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty