Provider Demographics
NPI:1669628087
Name:GOEBEL-ROBERTS, PAMELA S (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:GOEBEL-ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 E OSAGE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2090
Mailing Address - Country:US
Mailing Address - Phone:316-789-8222
Mailing Address - Fax:316-651-2344
Practice Address - Street 1:1720 E OSAGE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2090
Practice Address - Country:US
Practice Address - Phone:316-789-8222
Practice Address - Fax:316-651-2344
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-87426-072364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health