Provider Demographics
NPI:1477818680
Name:HAUGHOM, PAMELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:HAUGHOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:KOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3841 PIPER ST STE T4-020
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4673
Mailing Address - Country:US
Mailing Address - Phone:907-646-8500
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER ST STE T4-020
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4673
Practice Address - Country:US
Practice Address - Phone:907-646-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004350363AS0400X
AK120423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical