Provider Demographics
NPI:1629155841
Name:CHRISMAN, PAMELA JOAN (NP,CPNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOAN
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:NP,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:113 CHRISTIAN LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1350
Practice Address - Country:US
Practice Address - Phone:985-781-7353
Practice Address - Fax:985-781-7354
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN128025163WP0808X
MSR862193208000000X
LAAP06002363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04203516Medicaid
LA2104454Medicaid
MS$$$$$$$$$AOtherBLUE CROSS BLUE SHIELD