Provider Demographics
NPI:1811355258
Name:HORTON, PAMELA (CPCP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 US HIGHWAY 395 N STE 3
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5233
Mailing Address - Country:US
Mailing Address - Phone:775-783-1528
Mailing Address - Fax:
Practice Address - Street 1:1524 US HIGHWAY 395 N STE 3
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5233
Practice Address - Country:US
Practice Address - Phone:775-783-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV880491262246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
733OtherCPCP