Individual
KELLY PATTERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
77 W FOREST AVE STE 301, FLAGSTAFF, AZ 86001-1483
(928) 773-2280
Mailing address
661 CYPRESS WAY, TWIN FALLS, ID 83301-6885
(435) 512-9597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14079288
—
AZ
Enumeration date
08/07/2017
Last updated
08/07/2017
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