Healthcare Provider Details

I. General information

NPI: 1396796348
Provider Name (Legal Business Name): PAMELA R MOYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WOODLAND HILLS BLVD
FORT SCOTT KS
66701-8797
US

IV. Provider business mailing address

3011 N MICHIGAN ST
PITTSBURG KS
66762-2546
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-8040
  • Fax: 620-223-8002
Mailing address:
  • Phone: 620-231-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75716
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: