Provider Demographics
NPI:1720124944
Name:CLEVENGER, PAMELA LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LEE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:LEE
Other - Last Name:PARADEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:RR 1 BOX 282
Mailing Address - Street 2:
Mailing Address - City:CAVE IN ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919-9764
Mailing Address - Country:US
Mailing Address - Phone:618-289-4750
Mailing Address - Fax:
Practice Address - Street 1:520 W GUM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KY
Practice Address - Zip Code:42064-1516
Practice Address - Country:US
Practice Address - Phone:270-965-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1108115163W00000X
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse