Provider Demographics
NPI:1154502532
Name:WELLS, PAMELA BEAVER (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BEAVER
Last Name:WELLS
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:255 HOLSTON RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4448
Mailing Address - Country:US
Mailing Address - Phone:276-227-0206
Mailing Address - Fax:276-227-0846
Practice Address - Street 1:255 HOLSTON RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4448
Practice Address - Country:US
Practice Address - Phone:276-227-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012879363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2007005748-22OtherAMERICAN NURSES CREDENTIA
RN00000129532OtherREGISTERED NURSE
TNAPN0000012879OtherNURSE PRACTITIONER
TNMB2178552OtherDEA