Provider Demographics
NPI:1598757353
Name:PADGETT, PAMELA L (CRNA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:PADGETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TRAFALGAR RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7401
Mailing Address - Country:US
Mailing Address - Phone:870-535-7457
Mailing Address - Fax:870-535-2522
Practice Address - Street 1:525 WESTERN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4967
Practice Address - Country:US
Practice Address - Phone:501-327-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00259329OtherRRMCR/PGBA
AR157650001Medicaid
AR5Y522OtherBCBS
AR157650001Medicaid