Provider Demographics
NPI:1164011904
Name:DAGENHART, PAMELA LYNN
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:DAGENHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEWTON LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8120
Mailing Address - Country:US
Mailing Address - Phone:865-483-8801
Mailing Address - Fax:865-482-0561
Practice Address - Street 1:110 NEWTON LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8120
Practice Address - Country:US
Practice Address - Phone:865-483-8801
Practice Address - Fax:865-482-0561
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000027297253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care