Provider Demographics
NPI:1497021877
Name:MYERS, PAMELA DALE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DALE
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:HETHERINGTON
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:447 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-2564
Mailing Address - Country:US
Mailing Address - Phone:724-258-2070
Mailing Address - Fax:855-475-6063
Practice Address - Street 1:447 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-2564
Practice Address - Country:US
Practice Address - Phone:724-258-2070
Practice Address - Fax:855-475-6063
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP0011999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner