Provider Demographics
NPI:1649366469
Name:GESFORD, PAMELA KAY (BSN,RN,CDE)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:GESFORD
Suffix:
Gender:F
Credentials:BSN,RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:SUITE 3650
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9003
Mailing Address - Country:US
Mailing Address - Phone:304-264-1000
Mailing Address - Fax:304-263-7246
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:STE 3650
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:304-263-7246
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30511163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMT02611Medicare PIN