Provider Demographics
NPI:1548225881
Name:NEAL, PAMELA S (BC-APRN, FNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:NEAL
Suffix:
Gender:F
Credentials:BC-APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2058
Mailing Address - Country:US
Mailing Address - Phone:606-324-1070
Mailing Address - Fax:606-324-1071
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 445
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-324-1070
Practice Address - Fax:606-324-1071
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35474363LF0000X
KY3007159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003940Medicaid
KY78015427Medicaid
WV3810003940Medicaid
WVQ54353Medicare UPIN