Provider Demographics
NPI:1699704387
Name:EATON, PATRECIA ELISE (PA)
Entity type:Individual
Prefix:
First Name:PATRECIA
Middle Name:ELISE
Last Name:EATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRECIA
Other - Middle Name:ELISE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:150 LONG RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763
Mailing Address - Country:US
Mailing Address - Phone:865-376-5807
Mailing Address - Fax:865-590-0069
Practice Address - Street 1:2497 SOUTH ROANE ST
Practice Address - Street 2:STE 240
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748
Practice Address - Country:US
Practice Address - Phone:865-590-0889
Practice Address - Fax:865-590-0884
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1137363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3664393Medicare ID - Type Unspecified
Q68314Medicare UPIN