MEDICARE: KIMBERLY MARIE PATTON N.P.

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	363L00000X	Nurse Practitioner	785291	TX

General Provider Information

NPI Number	:	1679906218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MARIE PATTON N.P.

Provider Business Mailing Address
First Line	:	1264 TAMU
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-0001
Country	:	US
Telephone Number	:	979-458-8310
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 HOUSTON ST
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-1236
Country	:	US
Telephone Number	:	979-458-9310
Fax Number	:

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	12/04/2017

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