Provider Demographics
NPI:1679514178
Name:MCCOOL, PAMELA Z (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:Z
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 ROAD 399
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-8602
Mailing Address - Country:US
Mailing Address - Phone:601-663-1200
Mailing Address - Fax:601-663-1379
Practice Address - Street 1:1001 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2161
Practice Address - Country:US
Practice Address - Phone:601-663-1200
Practice Address - Fax:601-663-1379
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR672726367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124160Medicaid
MS430001015Medicare ID - Type Unspecified