Provider Demographics
NPI:1376010934
Name:PAMELA GIVEANS NP PLLC
Entity Type:Organization
Organization Name:PAMELA GIVEANS NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIVEANS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:985-290-0402
Mailing Address - Street 1:8990 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4176
Mailing Address - Country:US
Mailing Address - Phone:228-331-3310
Mailing Address - Fax:228-284-1608
Practice Address - Street 1:8990 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4176
Practice Address - Country:US
Practice Address - Phone:228-331-3310
Practice Address - Fax:228-284-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03570021Medicaid