Provider Demographics
NPI:1992388060
Name:COLEMAN-SNOW, PAMELA DENISE (PMHNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:COLEMAN-SNOW
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DENISE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:28039 SCOTT RD STE D-231
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7479
Mailing Address - Country:US
Mailing Address - Phone:951-205-0715
Mailing Address - Fax:
Practice Address - Street 1:1707 EYE ST., STE. 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-310-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017697363LP0808X
CA548317163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty