Healthcare Provider Details

I. General information

NPI: 1164680450
Provider Name (Legal Business Name): MS. STEPHANIE PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 OLIVE BLVD
SAINT LOUIS MO
63130-2323
US

IV. Provider business mailing address

7271 OLIVE BLVD
SAINT LOUIS MO
63130-2323
US

V. Phone/Fax

Practice location:
  • Phone: 314-283-1335
  • Fax:
Mailing address:
  • Phone: 314-283-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number293342200
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: