Provider Demographics
NPI:1245939040
Name:VALENTINE, PAMELA LYNNE (PRSS, BHWC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNNE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:PRSS, BHWC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNNE
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAMELA HEIDERSTADT
Mailing Address - Street 1:2617 GENERAL PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6437
Mailing Address - Country:US
Mailing Address - Phone:405-858-1750
Mailing Address - Fax:
Practice Address - Street 1:205 S ACADEMY RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-8727
Practice Address - Country:US
Practice Address - Phone:405-858-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171400000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171400000XOther Service ProvidersHealth & Wellness Coach