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General NPI Number Information
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NPI Number | 1386438133
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Entity Type | Individual
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Provider Name | PATRICK MCCONNON
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Gender | Male
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1190 PATTERSON LAKE RD SE APT 1
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3921
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Country | US
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Telephone | 256-499-2708
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 PATTERSON LAKE RD SE APT 1
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3921
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Country | US
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Telephone | 256-499-2708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 3003307719
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 3003307719
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License Number State | AL
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