Provider Demographics
NPI:1629094677
Name:WEST, PAMELA LOUISE (APN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LOUISE
Last Name:WEST
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:LOUISE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:P. O. BOX 71
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-0071
Mailing Address - Country:US
Mailing Address - Phone:423-837-6243
Mailing Address - Fax:
Practice Address - Street 1:215 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347
Practice Address - Country:US
Practice Address - Phone:423-942-3962
Practice Address - Fax:423-942-6895
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN118414363L00000X
TNAPN0000007705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39075641OtherMEDICARE ID/UNSPECIFIED
TN4262148OtherBCBS-TN
TN4262148OtherBCBS-TN
P78119Medicare UPIN