Provider Demographics
NPI:1023108180
Name:ATKINSON, PAMELA R (MSN FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ROLLIE MOORE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2351
Mailing Address - Country:US
Mailing Address - Phone:618-997-5311
Mailing Address - Fax:618-252-6595
Practice Address - Street 1:608 ROLLIE MOORE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2351
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:618-252-6595
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001944363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077854Medicaid
ILP10866Medicare UPIN
ILP10866Medicare PIN