Provider Demographics
NPI:1336847177
Name:SMITH, PAMELA J (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:8813 BRUSHY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7441
Mailing Address - Country:US
Mailing Address - Phone:432-599-8891
Mailing Address - Fax:
Practice Address - Street 1:8813 BRUSHY CREEK TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7441
Practice Address - Country:US
Practice Address - Phone:432-599-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110860363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health