Provider Demographics
NPI:1659620730
Name:DREVER, PAMALA GAIL (ACNP)
Entity Type:Individual
Prefix:MS
First Name:PAMALA
Middle Name:GAIL
Last Name:DREVER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 WEST OAKS CIRCLE S
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:254-681-2227
Mailing Address - Fax:
Practice Address - Street 1:6104 WEST OAKS CIRCLE S
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:254-681-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254755363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659620730OtherTRICARE
TX182797400OtherDEPARTMENT OF LABOR
TX760555765OtherUNITED HEALTHCARE
TX881N40OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX1659620730OtherTRICARE SOUTH
TX312319201Medicaid
TX760555765OtherUNITED HEALTHCARE