Provider Demographics
NPI:1801075122
Name:PATAKENS LTD
Entity type:Organization
Organization Name:PATAKENS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS,C-FNP
Authorized Official - Phone:928-753-3332
Mailing Address - Street 1:PO BOX 6215
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-6215
Mailing Address - Country:US
Mailing Address - Phone:928-753-3332
Mailing Address - Fax:928-753-2662
Practice Address - Street 1:1871 GATES AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4017
Practice Address - Country:US
Practice Address - Phone:928-753-3332
Practice Address - Fax:928-753-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN049098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431817Medicaid
AZDE5233OtherRAILROAD MEDICARE
AZZ109407Medicare PIN
AZ431817Medicaid