Healthcare Provider Details

I. General information

NPI: 1033193651
Provider Name (Legal Business Name): PAMELA PITT JONES FNP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 STATE ROUTE 244
ALFRED STATION NY
14803
US

IV. Provider business mailing address

578 STATE ROUTE 244
ALFRED STATION NY
14803
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-9389
  • Fax: 607-587-9389
Mailing address:
  • Phone: 607-587-9389
  • Fax: 607-587-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332476-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: