Provider Demographics
NPI:1720613243
Name:PATTEN, LATISHA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:PATTEN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 HIGGINS CIR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-3444
Mailing Address - Country:US
Mailing Address - Phone:706-518-7034
Mailing Address - Fax:
Practice Address - Street 1:1508 HIGGINS CIR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:GA
Practice Address - Zip Code:31833-3444
Practice Address - Country:US
Practice Address - Phone:706-518-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222762163W00000X
AL1-158365163W00000X
GA222762363LP0200X
AL3-001326363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse