Provider Demographics
NPI:1699344804
Name:PATTON, KARI LYNN
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:LYNN
Last Name:PATTON
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 1:152 BROADWAY STREET WEST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56369
Mailing Address - Country:US
Mailing Address - Phone:320-493-9649
Mailing Address - Fax:
Practice Address - Street 1:152 BROADWAY STREET WEST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MN
Practice Address - Zip Code:56369-5636
Practice Address - Country:US
Practice Address - Phone:320-493-9649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1102661253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency