Healthcare Provider Details

I. General information

NPI: 1285393090
Provider Name (Legal Business Name): KENYATA PATTERSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 HIGHWAY 239
CLAYTON AL
36016-4618
US

IV. Provider business mailing address

379 HIGHWAY 239
CLAYTON AL
36016-4618
US

V. Phone/Fax

Practice location:
  • Phone: 334-775-3610
  • Fax: 334-775-3062
Mailing address:
  • Phone: 334-775-3610
  • Fax: 334-775-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-149377
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: