Provider Demographics
NPI:1255406633
Name:ROY, PATRICE M (APMHNP/CNS)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:ROY
Suffix:
Gender:F
Credentials:APMHNP/CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ANDOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3848
Mailing Address - Country:US
Mailing Address - Phone:207-662-2208
Mailing Address - Fax:207-662-3110
Practice Address - Street 1:124 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3848
Practice Address - Country:US
Practice Address - Phone:207-662-2208
Practice Address - Fax:207-662-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNS84085364S00000X
MECNP81181363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22634Medicare UPIN
ME002666301Medicare PIN
METX4413Medicare PIN