Provider Demographics
NPI:1598370066
Name:PATTERSON, LACI N
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:N
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 PROSPER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151-8811
Mailing Address - Country:US
Mailing Address - Phone:405-220-2032
Mailing Address - Fax:
Practice Address - Street 1:3555 NW 58TH ST STE 910-W
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4707
Practice Address - Country:US
Practice Address - Phone:405-885-0270
Practice Address - Fax:405-300-4492
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered