Provider Demographics
NPI:1366687121
Name:CASSELL, PAMELA KEELEY (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KEELEY
Last Name:CASSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 STARKEY RD, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY RD
Practice Address - Street 2:STE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0622
Practice Address - Country:US
Practice Address - Phone:540-375-3790
Practice Address - Fax:540-375-8621
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC12133OtherMEDICARE
VA1366687121Medicaid
P00679395OtherRR MEDICARE