Provider Demographics
NPI:1467458141
Name:ISON-GLOVER, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ISON-GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-1002
Mailing Address - Country:US
Mailing Address - Phone:270-886-8468
Mailing Address - Fax:270-886-8472
Practice Address - Street 1:1720 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3684
Practice Address - Country:US
Practice Address - Phone:270-886-8468
Practice Address - Fax:270-886-8472
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0317237700000X, 237700000X
KYKY94231H00000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000064989OtherBCBS
KY70000948Medicaid
KY000000064989OtherBCBS
KYR39950Medicare UPIN