Provider Demographics
NPI:1962698548
Name:WHEAT, PATRINA ANACKER (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRINA
Middle Name:ANACKER
Last Name:WHEAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PATRINA
Other - Middle Name:LYNN
Other - Last Name:ANACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2365 IRON POINT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8713
Mailing Address - Country:US
Mailing Address - Phone:925-282-1778
Mailing Address - Fax:415-296-5299
Practice Address - Street 1:2365 IRON POINT RD STE 210
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8713
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:415-296-5299
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022598103TC0700X
CA27349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01CROtherMEDI-CAL