Provider Demographics
NPI:1649161225
Name:PATTERSON, JAKE CONLEY
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:CONLEY
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-2627
Mailing Address - Country:US
Mailing Address - Phone:918-839-5640
Mailing Address - Fax:
Practice Address - Street 1:1208 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-2627
Practice Address - Country:US
Practice Address - Phone:918-839-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program