Provider Demographics
NPI:1558412999
Name:SOLOMON, PAMELA S (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 N KENTUCKY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2089
Mailing Address - Country:US
Mailing Address - Phone:417-257-5911
Mailing Address - Fax:417-257-5913
Practice Address - Street 1:181 N KENTUCKY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2089
Practice Address - Country:US
Practice Address - Phone:417-257-5911
Practice Address - Fax:417-257-5913
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO127875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41736Medicare UPIN