Healthcare Provider Details

I. General information

NPI: 1053729756
Provider Name (Legal Business Name): PAMELA TESS SMALLWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W SUN ST
MOREHEAD KY
40351-1563
US

IV. Provider business mailing address

UNIVERSITY OF KENTUCKY RM C-368
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 606-207-2931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3624
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTP593
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: