JOHN WALTER PATRICK (NPI# 1720015274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720015274 |
| Entity Type | Individual |
| Full Name | JOHN WALTER PATRICK |
| Credential | PH.D. |
| Practice Address |
4643 S Clyde Morris Blvd Suite 306 Port Orange FL 32129-6000 |
| Mailing Address |
5911 Riverside Dr Port Orange FL 32127-6445 |
| Practice Telephone | 3867613101 |
| Mailing Telephone | 3867613101 |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PY3313 | FL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255952297 | John Thomas Patrick | Psychologist | 2400 Hospital Rd, Tuskegee, AL 36083-5001 | 2020-04-30 |
| 1457905325 | John Patrick | Community Health Worker | 501 Albany Ave, Torrington, WY 82240-1503 | 2019-07-30 |
| 1235632241 | John Oliver Patrick | General Practice | 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234-4504 | 2018-03-15 |
| 1568736577 | John J Patrick | Nurse Practitioner | 2429 M St, Omaha, NE 68107-2715 | 2012-03-08 |
| 1497790455 | John T Patrick | Specialist | 4120 Del Prado Blvd S, Cape Coral, FL 33904-7165 | 2006-06-16 |
| 1932147105 | John D. Patrick | Chiropractor | 3850 E Lohman Ave, Ste 100, Las Cruces, NM 88011-8288 | 2006-06-02 |
| 1528038882 | John Patrick | Emergency Medicine | 330 Mount Auburn St, Walk-in Center, Cambridge, MA 02138-5502 | 2006-01-26 |
| 1861487902 | John D. Patrick | Specialist | 501 N Elam Ave, Greensboro, NC 27403-1118 | 2005-09-14 |
| 1124023023 | John W Patrick | Radiology | 801 W Gordon St, Thomaston, GA 30286-3426 | 2005-06-16 |
| Street Address |
4643 S CLYDE MORRIS BLVD SUITE 306 |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32129-6000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841223898 | Concetta Tina A Pomroy | Counselor | 4643 S Clyde Morris Blvd, Suite 306, Port Orange, FL 32129-6000 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982179818 | Port Orange Modern Dentistry, Pa | Dentist | 1765 Dunlawton Ave., Suite 103, Port Orange, FL 32129 | 2018-10-08 |
| 1932698131 | Brittany Michele Claude | Behavioral Analyst | 4647 Clyde Morris Blvd Suite 501, Port Orange, FL 32129 | 2018-05-03 |
| 1760919468 | Makayla Earl | Behavior Technician | 1557 Town Park Dr., Port Orange, FL 32129 | 2017-05-12 |
| 1184157968 | Katie Lynn Weisz | Physician Assistant | 3635 South Clyde Morris Blvd, Suite 100, Port Orage, FL 32129 | 2017-04-07 |
| 1285178319 | Mallory Driggers | Counselor | 980 Canal View Blvd Apt F7, Port Orange, FL 32129 | 2016-12-08 |
| 1912321654 | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph | Dentist | 944 Bridgewater Dr., Suite 2-b, Port Orange, FL 32129 | 2014-02-18 |
| 1538411731 | Roberta Ann Gilmartin | Specialist | 1048 W Samms Ave, Port Orange, FL 32129 | 2012-10-11 |
| 1679892996 | Pamela Kirby Pa | Clinic/Center | 4606 South Clyde Morris Boulevard, Suite 1j, Port Orange, FL 32129 | 2010-05-26 |
| 1326376385 | Connie Jeanne Bodnarik | Physical Therapy Assistant | 3780 S Clyde Morris Blvd Apt 1206, Port Orange, FL 32129 | 2009-12-02 |
| 1669645057 | American Family & Sports Chiropractic Center Inc | Chiropractor | 4649 Clyde Morris Blvd Unit 609, Port Orange, FL 32129 | 2008-04-08 |
| Find all providers in zip 32129 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740224 | North Florida Collaborative Therapy | Psychologist | 9652 Morgan Creek Ct, Jacksonville, FL 32222-5808 | 2020-11-05 |
| 1922607381 | Michelle Mcnally | Psychologist | 6945 Halton Park Ln, Coconut Creek, FL 33073-2170 | 2020-10-18 |
| 1427665322 | Salubrious Psychological Services | Psychologist | 865 Nw 208th Cir, Pembroke Pines, FL 33029-1908 | 2020-09-25 |
| 1396351979 | Daniela Oliveira De Medeiros | Psychologist | 111 Majorca Ave # B, Coral Gables, FL 33134-4508 | 2020-09-19 |
| 1235744327 | Lisa Stewart | Psychologist | 13000 Bruce B Downs Blvd Bldg 68, Tampa, FL 33612-4745 | 2020-09-15 |
| 1265047047 | Anissa York | Psychologist | 6760 Congress Ave Apt 203, Boca Raton, FL 33487-1242 | 2020-09-09 |
| 1154935781 | Caressa Alice Slocum | Psychologist | 840 Dr M.l.k. Jr St N, St. Petersburg, FL 33705 | 2020-09-01 |
| 1497365399 | Julia L Sheffler | Psychologist | 1126b Lee Ave, Tallahassee, FL 32303-6508 | 2020-08-05 |
| 1801413315 | Steven David Macchione | Psychologist | 328 Nw 97th Ave, Plantation, FL 33324-7068 | 2020-06-30 |
| 1578180154 | Lory Jean Reyes | Psychologist | 1180 N Federal Hwy Ph 1608, Fort Lauderdale, FL 33304-1470 | 2020-06-30 |
| Find all providers with the same taxonomy | ||||
| City | PORT ORANGE |
| Zip Code | 32129 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.