Healthcare Provider Details

I. General information

NPI: 1780565879
Provider Name (Legal Business Name): KIMBERLY CAROL PATTERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

IV. Provider business mailing address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2266
  • Fax: 855-348-3430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83271-121
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-83271-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: