Provider Demographics
NPI:1225198484
Name:WHIBBY, PAMELA A (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:WHIBBY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 DEWFIELD N DR
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8980
Mailing Address - Country:US
Mailing Address - Phone:860-805-7162
Mailing Address - Fax:
Practice Address - Street 1:3009 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2422
Practice Address - Country:US
Practice Address - Phone:252-443-2552
Practice Address - Fax:252-443-0936
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102315363A00000X
NY0056791363A00000X
CT000737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1225198484OtherBCBS
NC1225198484Medicaid