Provider Demographics
NPI:1912043878
Name:PEPPER, PAMELA LASONDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LASONDRA
Last Name:PEPPER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CLOVERLY PL
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7252
Mailing Address - Country:US
Mailing Address - Phone:501-305-3108
Mailing Address - Fax:
Practice Address - Street 1:3302 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4886
Practice Address - Country:US
Practice Address - Phone:501-268-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0618APPL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical