Provider Demographics
NPI:1215111778
Name:PATTON, CAROLYN LOUISE (RN MSN FNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:PATTON
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635022
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-5022
Mailing Address - Country:US
Mailing Address - Phone:936-569-8240
Mailing Address - Fax:936-569-2217
Practice Address - Street 1:1407 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5369
Practice Address - Country:US
Practice Address - Phone:936-569-8240
Practice Address - Fax:936-569-2217
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX604704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193249302Medicaid
291334YSL8OtherMEDICARE