Provider Demographics
NPI:1467681916
Name:RIDDLE, PAMELA RENEE (BS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 E NORTHSHIRE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1494
Mailing Address - Country:US
Mailing Address - Phone:918-899-5291
Mailing Address - Fax:
Practice Address - Street 1:2 S COO Y YAH ST # 4
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4636
Practice Address - Country:US
Practice Address - Phone:918-824-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator