Healthcare Provider Details

I. General information

NPI: 1780593848
Provider Name (Legal Business Name): DEONDRE PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 JOHNSON DR
MISSION KS
66202-2616
US

IV. Provider business mailing address

333 W 46TH TER
KANSAS CITY MO
64112-1545
US

V. Phone/Fax

Practice location:
  • Phone: 573-200-6476
  • Fax:
Mailing address:
  • Phone: 314-374-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: