Healthcare Provider Details

I. General information

NPI: 1053138362
Provider Name (Legal Business Name): PAMELA BREANN SEBASTIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N MAIN ST STE 120
HAZARD KY
41701-2503
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2662
  • Fax:
Mailing address:
  • Phone: 606-435-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4028208
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: