Provider Demographics
NPI:1326236597
Name:JONES, PAMELA MERITA (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MERITA
Last Name:JONES
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:MERITA
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,NP
Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:130 TOWN CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1744
Practice Address - Country:US
Practice Address - Phone:248-740-0670
Practice Address - Fax:248-740-0668
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704194406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500867243OtherBCBSM
MICB9133OtherRAILROAD MEDICARE
MIP12960009Medicare PIN