Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2007006345 | MO |
NPI | 1063815272 |
---|---|
Provider Name | Kerrie Nell Patton |
First Address | Hollister, MO 65672-5334 |
Second Address | Hollister, MO 65672-5334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 01/10/2014 |