Provider Demographics
NPI:1508300880
Name:COUNTRY PRIMARY CARE
Entity Type:Organization
Organization Name:COUNTRY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KELLER-ARLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:540-809-4454
Mailing Address - Street 1:8409 W HILDY CT
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-3623
Mailing Address - Country:US
Mailing Address - Phone:540-809-4454
Mailing Address - Fax:
Practice Address - Street 1:8409 W HILDY CT
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-3623
Practice Address - Country:US
Practice Address - Phone:540-809-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169540363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty