Provider Demographics
NPI:1740291525
Name:CHRISCO, PAMELA J (APN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:CHRISCO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SE MACY RD
Mailing Address - Street 2:18
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-845-0880
Mailing Address - Fax:479-845-8887
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:18
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-845-0880
Practice Address - Fax:479-845-8887
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152203758Medicaid
AR152203758Medicaid