Provider Demographics
NPI:1831635929
Name:SMITH, PAMELA (BA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PEGGY LN
Mailing Address - Street 2:
Mailing Address - City:CHAVIES
Mailing Address - State:KY
Mailing Address - Zip Code:41727-9201
Mailing Address - Country:US
Mailing Address - Phone:606-373-4921
Mailing Address - Fax:
Practice Address - Street 1:48 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9443
Practice Address - Country:US
Practice Address - Phone:606-487-1646
Practice Address - Fax:606-487-1746
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator