Provider Demographics
NPI:1619958436
Name:PHARES, PAMELA (CNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:PHARES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 STEFFEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2338
Mailing Address - Country:US
Mailing Address - Phone:513-588-3623
Mailing Address - Fax:513-588-3649
Practice Address - Street 1:1401 STEFFEN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2338
Practice Address - Country:US
Practice Address - Phone:513-588-3623
Practice Address - Fax:513-588-3649
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 01325363LA2200X, 363LP0200X
IN72000082A367A00000X
OHNM 06641367A00000X
OHNP01325363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200426210Medicaid
OH2451234Medicaid
OH2451234Medicaid