Healthcare Provider Details

I. General information

NPI: 1548225881
Provider Name (Legal Business Name): PAMELA S NEAL BC-APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 23RD ST SUITE 445
ASHLAND KY
41101-2880
US

IV. Provider business mailing address

PO BOX 2058
ASHLAND KY
41105-2058
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-1070
  • Fax: 606-324-1071
Mailing address:
  • Phone: 606-324-1070
  • Fax: 606-324-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35474
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007159
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: