1841806551 NPI number — DR. PAMELA LOUISE SMITH PHD, FNP, RN

Table of content: DR. PAMELA LOUISE SMITH PHD, FNP, RN (NPI 1841806551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841806551 NPI number — DR. PAMELA LOUISE SMITH PHD, FNP, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PAMELA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, FNP, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS-SMITH
Provider Other First Name:
PAMELA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, FNP, RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841806551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1210 DANFORTH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-6234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-864-5098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 E BROADWAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-815-8242
Provider Business Practice Location Address Fax Number:
573-815-8245
Provider Enumeration Date:
09/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  120866 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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