Provider Demographics
NPI:1902454317
Name:PATTERSON, KRISTIN BLAIR (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BLAIR
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30029 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-9361
Mailing Address - Country:US
Mailing Address - Phone:662-610-5336
Mailing Address - Fax:
Practice Address - Street 1:1215 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5509
Practice Address - Country:US
Practice Address - Phone:731-394-1145
Practice Address - Fax:844-374-0233
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily