Provider Demographics
NPI:1396907655
Name:GIVEANS, PAMELA L (APRN BC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:GIVEANS
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4176
Mailing Address - Country:US
Mailing Address - Phone:228-331-3310
Mailing Address - Fax:228-284-1608
Practice Address - Street 1:8990 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4176
Practice Address - Country:US
Practice Address - Phone:228-331-3310
Practice Address - Fax:228-284-1608
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875477163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03570021Medicaid
MS512I500580Medicare UPIN
MS03570021Medicaid