Provider Demographics
NPI:1598132979
Name:POLLY, PAMELA LOUISE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LOUISE
Last Name:POLLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LOUISE
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:89 LITTLE ACRE RD
Mailing Address - Street 2:
Mailing Address - City:LINEFORK
Mailing Address - State:KY
Mailing Address - Zip Code:41833
Mailing Address - Country:US
Mailing Address - Phone:757-751-1438
Mailing Address - Fax:
Practice Address - Street 1:3900 CROSBY DR
Practice Address - Street 2:APT 205
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1811
Practice Address - Country:US
Practice Address - Phone:757-751-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009401363LF0000X
VA0024172489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily