MEDICARE: DEANNA L PATTERSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN07770	TN
2	363LF0000X	Family Nurse Practitioner	RN119860	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00817727	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	TN01Q6	OTHER	TN	JOHN DEERE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4057118	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1639133473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA L PATTERSON FNP

Provider Business Mailing Address
First Line	:	2000 BROOKSIDE DR
Second Line	:	3RD FLOOR
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4627
Country	:	US
Telephone Number	:	423-857-5905
Fax Number	:	423-857-5904

Provider Business Practice Location Address
First Line	:	2000 BROOKSIDE DR
Second Line	:	3RD FLOOR
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4627
Country	:	US
Telephone Number	:	423-857-5905
Fax Number	:	423-857-5904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	12/23/2014

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