MEDICARE: STEPHANIE PATTON

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	103TS0200X	School Psychologist	92498	NV

General Provider Information

NPI Number	:	1588915227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PATTON

Provider Business Mailing Address
First Line	:	68 E SERENE AVE
Second Line	:	222
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3732
Country	:	US
Telephone Number	:	828-403-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 W CHARLESTON BLVD
Second Line	:	120
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1572
Country	:	US
Telephone Number	:	828-403-3225
Fax Number	:

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

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	09/20/2012

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Directions to “ STEPHANIE PATTON ” Practice Location

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