Healthcare Provider Details

I. General information

NPI: 1538004262
Provider Name (Legal Business Name): OMAR OCTAVIOUS PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RABBIT EARS PT APT 1012
CULLOWHEE NC
28723-5892
US

IV. Provider business mailing address

32 RABBIT EARS PT APT 1012
CULLOWHEE NC
28723-5892
US

V. Phone/Fax

Practice location:
  • Phone: 941-769-2868
  • Fax:
Mailing address:
  • Phone: 941-769-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: