Active NPI
Kenneth Wayne Patton Sr.
- Peer Specialist
- Broken Arrow, OK
National Provider Identifier
1538946512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 2021-889
- Practice address
- 7323 E Nashville St
Broken Arrow, OK 74014-2980 - Phone
- (918) 853-5153
- NPI assigned
- Sep 12, 2023
- Last updated
- Sep 12, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 2021-889 | OK | Primary |
Addresses
Primary practice location
7323 E Nashville St
Broken Arrow, OK 74014-2980
Mailing address
7323 E Nashville St
Broken Arrow, OK 74014-2980
Phone (918) 853-5153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021-889 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1538946512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7323 E NASHVILLE ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740142980",
"telephone_number": "918-853-5153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7323 E NASHVILLE ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740142980",
"telephone_number": "918-853-5153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTON",
"first_name": "KENNETH",
"middle_name": "WAYNE",
"name_suffix": "Sr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-12",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "2021-889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
- Umang Patel
- Pathfinders United, LLC
- Patient Care Services of Saint Francis Inc (Patient Care Services of Saint Francis)
- Christian Patrzykont, PT, DPT, CSCS
- Julie Marie Patterson, MS, CCC-SLP
- Janelle Marshall Pavlis, M.D.
- Jacquelyn Dove Payne, PTA
- Rebecca Anne Payne, M.ED CCC-SLP
- William A Payne
- Peak Medical Oklahoma No. 3, Inc. (Forest Hills Care and Rehabilitation Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.