Healthcare Provider Details

I. General information

NPI: 1255734547
Provider Name (Legal Business Name): PAMELA S MCGOWEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 W 11TH ST
PANAMA CITY FL
32401-2330
US

IV. Provider business mailing address

597 W 11TH ST
PANAMA CITY FL
32401-2330
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-4455
  • Fax: 850-747-5475
Mailing address:
  • Phone: 850-872-4455
  • Fax: 850-747-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1750052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: