Provider Demographics
NPI:1487641007
Name:PRITCHETT, PAMELA JEAN BURSHOP (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN BURSHOP
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:1895 HOFFMAN RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-6557
Practice Address - Country:US
Practice Address - Phone:704-861-8669
Practice Address - Fax:704-865-5081
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCF66531363LF0000X
NC201833363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP920216221Medicare PIN
SCP92021Medicare UPIN
NC2592009BMedicare PIN