Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 53-76009-112 | KS |
NPI | 1174963912 |
---|---|
Provider Name | Kelli Marie Patton |
First Address | Lenexa, KS 66220-3353 |
Second Address | Lenexa, KS 66220-3353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 25/06/2013 |