Provider Demographics
NPI:1336211697
Name:CARVER, PAMELA KAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:CARVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:PERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:315 N FAIRPLAY ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3217
Mailing Address - Country:US
Mailing Address - Phone:864-650-2601
Mailing Address - Fax:
Practice Address - Street 1:200 FLEETWOOD DR
Practice Address - Street 2:PBMCE-ED
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2022
Practice Address - Country:US
Practice Address - Phone:864-442-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP90155Medicare UPIN