Provider Demographics
NPI:1942292743
Name:BENNETT, PAMELA ANN (PA C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 FAIRMONT PKWY
Mailing Address - Street 2:STE 202
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4045
Mailing Address - Country:US
Mailing Address - Phone:281-998-2488
Mailing Address - Fax:281-998-2482
Practice Address - Street 1:6243 FAIRMONT PKWY
Practice Address - Street 2:STE 202
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4045
Practice Address - Country:US
Practice Address - Phone:281-998-2488
Practice Address - Fax:281-998-2482
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP57698Medicare UPIN
TX87N851Medicare PIN