Healthcare Provider Details

I. General information

NPI: 1962495564
Provider Name (Legal Business Name): PAMELA HARDEE RHEUARK PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 12TH ST JOHN UMSTEAD HOSPITAL
BUTNER NC
27509-1626
US

IV. Provider business mailing address

300 VEAZEY DR
BUTNER NC
27509-1668
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-2237
  • Fax:
Mailing address:
  • Phone: 919-764-5228
  • Fax: 919-764-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number101012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: