1528365251 NPI NUMBER - DR. MICHELLE RENEE PATRICK, PH.D.
Summary
|
|
|
|
|
NPI Number |
1528365251 |
| Entity Type Code |
Individual |
| Provider Legal Name |
DR. MICHELLE RENEE PATRICK, PH.D. |
| Provider Business Practice Location Address |
611 N FOUNTAIN ST
CAPE GIRARDEAU, MO
ZIP 63701
|
| Practice Location Phone Number |
(573) 651-2705 |
| Provider Taxonomy Code |
103T00000X - Psychologist |
| Specialization |
|
| Provider Enumeration Date |
2/15/2011 |
| Last Update Date |
1/8/2013 |
NPI Number 1528365251 is assigned to an individual registered under the provider name DR. MICHELLE RENEE PATRICK, PH.D. .
The NPPES NPI record indicates the provider is a female.
The provider is physically located at:
611 N FOUNTAIN ST
CAPE GIRARDEAU, MO
ZIP 63701-244
Phone: (573) 651-2705
Fax: (573) 986-4994
The enumeration date for this NPI number is 2/15/2011 and was last updated on 1/8/2013 .
Map - Location of Practice
Taxonomy Codes
The following information regarding the scope of practice of this provider is available:
| 1 |
103T00000X |
Psychologist |
|
LP 1649 |
KS |
View Code |
| 2 |
103T00000X |
Psychologist |
|
2012038439 |
MO |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
NPI Record
| 1 |
NPI |
1528365251 |
| 2 |
Entity Type Code |
1 |
| 3 |
Provider Last Name Legal Name |
PATRICK |
| 4 |
Provider First Name |
MICHELLE |
| 5 |
Provider Middle Name |
RENEE |
| 6 |
Provider Name Prefix Text |
DR. |
| 7 |
Provider Credential Text |
PH.D. |
| 8 |
Provider First Line Business Practice Location Address |
611 N FOUNTAIN ST |
| 9 |
Provider Business Practice Location Address City Name |
CAPE GIRARDEAU |
| 10 |
Provider Business Practice Location Address State Name |
MO |
| 11 |
Provider Business Practice Location Address Postal Code |
637017244 |
| 12 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 13 |
Provider Business Practice Location Address Telephone Number |
5736512705 |
| 14 |
Provider Business Practice Location Address Fax Number |
5739864994 |
| 15 |
Provider Enumeration Date |
2/15/2011 |
| 16 |
Last Update Date |
1/8/2013 |
| 17 |
Provider Gender Code |
F |
| 18 |
Healthcare Provider Taxonomy Code 1 |
103T00000X |
| 19 |
Provider License Number 1 |
LP 1649 |
| 20 |
Provider License Number State Code 1 |
KS |
| 21 |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
| 22 |
Healthcare Provider Taxonomy Code 2 |
103T00000X |
| 23 |
Provider License Number 2 |
2012038439 |
| 24 |
Provider License Number State Code 2 |
MO |
| 25 |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
| 26 |
Is Sole Proprietor |
N |
Download Record
Download this NPI record in Text format: Export
Download this NPI record in Excel (CSV) format: Export
Download this NPI record in XML format: Export
This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.