Provider Demographics
NPI:1023815909
Name:PATRICK, MCKENNA KRISTINE
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:KRISTINE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N 350 E
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-9585
Mailing Address - Country:US
Mailing Address - Phone:765-891-1183
Mailing Address - Fax:
Practice Address - Street 1:5100 N 350 E
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-9585
Practice Address - Country:US
Practice Address - Phone:765-891-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician