Healthcare Provider Details

I. General information

NPI: 1073061461
Provider Name (Legal Business Name): PAMELA ALLCORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N BUTLER AVE
FARMINGTON NM
87401-6355
US

IV. Provider business mailing address

1036 BERTIE LN
BLOOMFIELD NM
87413-4404
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8607
  • Fax:
Mailing address:
  • Phone: 505-330-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberB-1097
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-09951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: