Provider Demographics
NPI:1225229073
Name:WHITLEY, PAMELA S (FNP-BC, CWOCN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:FNP-BC, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601529
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1529
Mailing Address - Country:US
Mailing Address - Phone:704-384-4098
Mailing Address - Fax:704-384-5743
Practice Address - Street 1:300 BILLINGSLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1075
Practice Address - Country:US
Practice Address - Phone:704-384-4098
Practice Address - Fax:704-384-5743
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201510363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000232Medicaid
NC2802507AMedicare PIN
NCP47366Medicare UPIN
NC7000232Medicaid
NC2802507CMedicare PIN