Provider Demographics
NPI:1205954906
Name:FAIL, PAMELA R (NP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:FAIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3007 HWY 15
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422
Mailing Address - Country:US
Mailing Address - Phone:601-764-3055
Mailing Address - Fax:
Practice Address - Street 1:15 A SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422
Practice Address - Country:US
Practice Address - Phone:601-764-2101
Practice Address - Fax:601-764-4789
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR629871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP48062Medicare UPIN