Healthcare Provider Details

I. General information

NPI: 1508181835
Provider Name (Legal Business Name): COURTNEY A PATTERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD STREET
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

PO BOX 11503
CHATTANOOGA TN
37401-2503
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6472
  • Fax: 423-778-4232
Mailing address:
  • Phone: 302-651-4488
  • Fax: 407-650-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN188522NP
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9319153
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: