Provider Demographics
NPI:1992870141
Name:NATION, PATRICA L (PHD)
Entity type:Individual
Prefix:
First Name:PATRICA
Middle Name:L
Last Name:NATION
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CARTER CREEK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4491
Mailing Address - Country:US
Mailing Address - Phone:979-260-6919
Mailing Address - Fax:979-260-6918
Practice Address - Street 1:4343 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4491
Practice Address - Country:US
Practice Address - Phone:979-260-6919
Practice Address - Fax:979-260-6918
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2-6887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX2-6887OtherLICENSE