Healthcare Provider Details

I. General information

NPI: 1437700101
Provider Name (Legal Business Name): CORTNIE L PATTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNIE L JORDAN NP

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 MAGNAVOX
FORT WAYNE IN
46804-1537
US

IV. Provider business mailing address

7619 W JEFFERSON BLVD
FORT WAYNE IN
46804-4133
US

V. Phone/Fax

Practice location:
  • Phone: 260-748-3650
  • Fax: 260-748-3651
Mailing address:
  • Phone: 260-407-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009770A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28225685A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: