Basic Information
| Provider Information | |||||||||
| NPI: | 1366584989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATRICK | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 322 OSBORNE LN | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371309588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158678010 | ||||||||
| FaxNumber: | 6158677955 | ||||||||
| Practice Location | |||||||||
| Address1: | 1004 N HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371302454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158677997 | ||||||||
| FaxNumber: | 6158677955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 463 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.