Provider Demographics
NPI:1548446008
Name:PATRICIA NATION, PHD
Entity type:Organization
Organization Name:PATRICIA NATION, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-260-6919
Mailing Address - Street 1:4343 CARTER CREEK PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4491
Mailing Address - Country:US
Mailing Address - Phone:979-260-6919
Mailing Address - Fax:979-260-6918
Practice Address - Street 1:4343 CARTER CREEK PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4491
Practice Address - Country:US
Practice Address - Phone:979-260-6919
Practice Address - Fax:979-260-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPSY#2-6887103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00738EMedicare PIN
TX549935Medicare UPIN