MEDICARE: PATRICK JEROME TOWNSEND JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4871	TN

General Provider Information

NPI Number	:	1275285090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK JEROME TOWNSEND JR. PA-C

Provider Business Mailing Address
First Line	:	8357 PRESTINE LOOP APT 203
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-4296
Country	:	US
Telephone Number	:	901-500-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	2693 UNION EXTENDED
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4403
Country	:	US
Telephone Number	:	901-726-0843
Fax Number	:	901-278-2695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2022
Last Update Date	:	05/19/2023

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