Healthcare Provider Details

I. General information

NPI: 1306277686
Provider Name (Legal Business Name): PATRIA MCKIERNAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 MANGROVE AVE
CHICO CA
95926-3509
US

IV. Provider business mailing address

1040 MANGROVE AVE
CHICO CA
95926-3509
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-0064
  • Fax: 530-345-0680
Mailing address:
  • Phone: 530-345-0064
  • Fax: 530-345-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number23798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: