Healthcare Provider Details

I. General information

NPI: 1053384883
Provider Name (Legal Business Name): PATTI J. KAMYKOWSKI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 UNION ST
SHELBYVILLE TN
37160-2607
US

IV. Provider business mailing address

PO BOX 65026
CHARLOTTE NC
28265-0026
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-5433
  • Fax: 931-685-5449
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN0000038923
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: