Basic Information
| Provider Information | |||||||||
| NPI: | 1336550508 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | JOHNNY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 SOUTH BUTLER ROAD | ||||||||
| Address2: | |||||||||
| City: | MOUNT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17064 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 283 BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170646085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172738871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2014 | ||||||||
| LastUpdateDate: | 06/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | L8-0000126 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | SP013760 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.