Healthcare Provider Details

I. General information

NPI: 1871698563
Provider Name (Legal Business Name): PAMELA JO WOMACK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 RINGSBY CT UNIT 102
DENVER CO
80216-4922
US

IV. Provider business mailing address

3455 RINGSBY CT UNIT 102
DENVER CO
80216-4922
US

V. Phone/Fax

Practice location:
  • Phone: 303-500-1518
  • Fax: 720-598-0440
Mailing address:
  • Phone: 303-500-1518
  • Fax: 720-598-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberRN0000064421
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4539
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9474400
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN290640
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: