Healthcare Provider Details

I. General information

NPI: 1043383607
Provider Name (Legal Business Name): PATRICIA KEHINDE DARE APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

7738 BAR HARBOR DR
RIVERDALE GA
30296-3357
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-0499
  • Fax: 404-294-0793
Mailing address:
  • Phone: 678-549-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN106769
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN106769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: