Healthcare Provider Details

I. General information

NPI: 1659071652
Provider Name (Legal Business Name): JONATHON WILLIAM PATMORE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVERSMAN DR
JASPER IN
47546-3548
US

IV. Provider business mailing address

480 EVERSMAN DR
JASPER IN
47546-3548
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-3020
  • Fax:
Mailing address:
  • Phone: 812-482-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: