Provider Demographics
NPI:1922043975
Name:WADDELL, PAMELA M (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:WADDELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6170 SHALLOWFORD RD
Mailing Address - Street 2:101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1892
Mailing Address - Country:US
Mailing Address - Phone:423-648-4500
Mailing Address - Fax:423-855-7563
Practice Address - Street 1:785 HIGHWAY 321 N
Practice Address - Street 2:24
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6502
Practice Address - Country:US
Practice Address - Phone:865-988-0096
Practice Address - Fax:865-988-0189
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN6828363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3902480Medicare ID - Type Unspecified
TN1016710001Medicare NSC
S80547Medicare UPIN