Provider Demographics
NPI:1538143201
Name:PRIEST, PAMELA GREGORY (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GREGORY
Last Name:PRIEST
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Gender:F
Credentials:NP
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:101 PHILIP ROTH ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1393
Practice Address - Country:US
Practice Address - Phone:757-599-6333
Practice Address - Fax:757-591-7261
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-02-07
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Provider Licenses
StateLicense IDTaxonomies
VA0024164006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538143201Medicaid
VA022203R53Medicare PIN
VAP51765Medicare UPIN