Healthcare Provider Details

I. General information

NPI: 1639133473
Provider Name (Legal Business Name): DEANNA L PATTERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BROOKSIDE DR 3RD FLOOR
KINGSPORT TN
37660-4627
US

IV. Provider business mailing address

2000 BROOKSIDE DR 3RD FLOOR
KINGSPORT TN
37660-4627
US

V. Phone/Fax

Practice location:
  • Phone: 423-857-5905
  • Fax: 423-857-5904
Mailing address:
  • Phone: 423-857-5905
  • Fax: 423-857-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN07770
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN119860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: