Provider Demographics
NPI:1215218458
Name:PATTERSON, DEIDRA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:MICHELLE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 TEXAS AVE STE 2061
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3944
Mailing Address - Country:US
Mailing Address - Phone:318-448-1041
Mailing Address - Fax:318-487-4596
Practice Address - Street 1:2108 TEXAS AVE STE 2061
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-448-1041
Practice Address - Fax:318-487-4596
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA134645163W00000X
AL1-070025163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse