Provider Demographics
NPI:1942476734
Name:KLINKNER, PAMELA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:KLINKNER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2680 LEONARD ST NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-949-9944
Mailing Address - Fax:616-949-4978
Practice Address - Street 1:2680 LEONARD ST NE
Practice Address - Street 2:SUITE 2
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-224-1515
Practice Address - Fax:616-224-2070
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2018-09-25
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Provider Licenses
StateLicense IDTaxonomies
MI5601002825363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical