Provider Demographics
NPI:1114221785
Name:SMITH, PAMELA IDELLA (RN, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:IDELLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 CALIFONIA AVE.
Mailing Address - Street 2:STE. 500
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-716-3484
Mailing Address - Fax:661-716-5484
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:B-231
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-665-0505
Practice Address - Fax:661-665-7844
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 20310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily