Provider Demographics
NPI:1760516587
Name:LEWIS, PAMELA A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:A
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1364 CTY RD 432
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-266-0156
Mailing Address - Fax:
Practice Address - Street 1:2130 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2907
Practice Address - Country:US
Practice Address - Phone:573-243-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner