Provider Demographics
NPI:1427027598
Name:WILLS, PAMELA JANELLE (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANELLE
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JANELLE
Other - Last Name:WILLS
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:STE 400
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-907-1204
Mailing Address - Fax:501-228-0983
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:STE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-907-1204
Practice Address - Fax:501-228-0983
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54295Medicare ID - Type Unspecified
ARE57605Medicare UPIN