Provider Demographics
NPI:1720129380
Name:MYERS, PAMELA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-1348
Mailing Address - Country:US
Mailing Address - Phone:336-667-5296
Mailing Address - Fax:336-667-0864
Practice Address - Street 1:702 13TH ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4075
Practice Address - Country:US
Practice Address - Phone:336-667-5296
Practice Address - Fax:336-667-0864
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100774363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102199Medicaid
NC8102199Medicaid
NC2763952BMedicare PIN
R49051Medicare UPIN