Provider Demographics
NPI:1194799130
Name:PATTERSON, JOANNA L (PA)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:L
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:JOANNA
Other - Middle Name:L
Other - Last Name:KANNADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8338 W 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2900
Mailing Address - Country:US
Mailing Address - Phone:316-729-1030
Mailing Address - Fax:316-729-0268
Practice Address - Street 1:8338 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2900
Practice Address - Country:US
Practice Address - Phone:316-729-1030
Practice Address - Fax:316-729-0268
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20359910AMedicaid
KS200359910GMedicaid
KS200359910DMedicaid
Q59765Medicare UPIN
KSKA2473003Medicare PIN
KS20359910AMedicaid
KS200359910DMedicaid