Provider Demographics
NPI:1164690236
Name:HIMSTEDT, PAMELA KAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:HIMSTEDT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 BLATTNER DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6364
Mailing Address - Country:US
Mailing Address - Phone:573-335-0166
Mailing Address - Fax:573-335-7942
Practice Address - Street 1:3129 BLATTNER DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6364
Practice Address - Country:US
Practice Address - Phone:573-335-0166
Practice Address - Fax:573-335-7942
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO099824363LF0000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425114907Medicaid
MOP00607758OtherRR MCR
MOP00607758OtherRR MCR
MO425114907Medicaid