Healthcare Provider Details

I. General information

NPI: 1932047990
Provider Name (Legal Business Name): PAMELA COSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA MCCOLLUM

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 VILLAGE ST STE A
SLIDELL LA
70458-5302
US

IV. Provider business mailing address

8326 KELWOOD AVE
BATON ROUGE LA
70806-4803
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: