Provider Demographics
NPI:1346226636
Name:PRICE, PAMELA (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3109
Mailing Address - Country:US
Mailing Address - Phone:540-387-0441
Mailing Address - Fax:540-375-9189
Practice Address - Street 1:1935 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3109
Practice Address - Country:US
Practice Address - Phone:540-387-0441
Practice Address - Fax:540-375-9189
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169155363LF0000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001718077OtherWV BCBS
WV1069586OtherWV DWC
WV3810001608Medicaid
WVP00198088Medicare PIN
WVP00198022Medicare PIN
WVQ27664Medicare UPIN
WVPRNP16611Medicare PIN
WV3810001608Medicaid
WVPRNP16613Medicare PIN