Provider Demographics
NPI:1982755351
Name:BRICKER, PAMELA ANN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:BRICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CHEYENNE BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2423
Mailing Address - Country:US
Mailing Address - Phone:719-635-8852
Mailing Address - Fax:719-434-7995
Practice Address - Street 1:730 CHEYENNE BLVD # 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-2423
Practice Address - Country:US
Practice Address - Phone:719-635-8852
Practice Address - Fax:719-434-7995
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70140364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health