Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 062122-23 | NH |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 062122-23 | NH |
NPI | 1043465156 |
---|---|
Provider Name | Patrick Ryan Lee Kadilak |
First Address | Apo, AE 09180-0003 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 21/02/2019 |