Provider Demographics
NPI:1376011650
Name:STAR BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:STAR BEHAVIORAL HEALTH, PLLC
Other - Org Name:STAR HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:540-512-9754
Mailing Address - Street 1:3505 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6521
Mailing Address - Country:US
Mailing Address - Phone:540-512-9754
Mailing Address - Fax:540-512-9148
Practice Address - Street 1:3505 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6521
Practice Address - Country:US
Practice Address - Phone:540-512-9754
Practice Address - Fax:540-512-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992868657Medicaid