Provider Demographics
NPI:1962838540
Name:WHITELEY, PAMELA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:WHITELEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 OLD RIVER RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9504
Mailing Address - Country:US
Mailing Address - Phone:661-664-0434
Mailing Address - Fax:661-664-0432
Practice Address - Street 1:500 OLD RIVER RD
Practice Address - Street 2:SUITE 145
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9504
Practice Address - Country:US
Practice Address - Phone:661-664-0434
Practice Address - Fax:661-664-0432
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant