Healthcare Provider Details

I. General information

NPI: 1538092499
Provider Name (Legal Business Name): ROCHELLE DENIECE PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5049 OLD JAMESTOWN FOREST DR
BLACK JACK MO
63033-8525
US

IV. Provider business mailing address

5049 OLD JAMESTOWN FOREST DR
BLACK JACK MO
63033-8525
US

V. Phone/Fax

Practice location:
  • Phone: 314-753-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2001015686
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: