Provider Demographics
NPI:1992806863
Name:CARRICK, PATRICIA (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:CARRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HWY 91 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3513
Mailing Address - Country:US
Mailing Address - Phone:406-683-4440
Mailing Address - Fax:406-683-1121
Practice Address - Street 1:30 HWY 91 S
Practice Address - Street 2:SUITE 100
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3513
Practice Address - Country:US
Practice Address - Phone:406-683-4440
Practice Address - Fax:406-683-1121
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN017332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S29612Medicare UPIN