Healthcare Provider Details

I. General information

NPI: 1033912605
Provider Name (Legal Business Name): PATRICIA ANN DEVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN # 4
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

395 CLEAR SPRINGS CT
CARLISLE OH
45005-7322
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax:
Mailing address:
  • Phone: 937-287-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberYU1004590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: