Healthcare Provider Details

I. General information

NPI: 1417893942
Provider Name (Legal Business Name): PAMELA ANN LITTLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 BARRON RD
POPLAR BLUFF MO
63901-1906
US

IV. Provider business mailing address

6611 COUNTY ROAD 523
WILLIAMSVILLE MO
63967-8140
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-6536
  • Fax: 573-785-0345
Mailing address:
  • Phone: 573-429-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026018005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: