Healthcare Provider Details

I. General information

NPI: 1629094677
Provider Name (Legal Business Name): PAMELA LOUISE WEST APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LOUISE WEST NP

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HICKMAN RD
JASPER TN
37347
US

IV. Provider business mailing address

P. O. BOX 71
SOUTH PITTSBURG TN
37380-0071
US

V. Phone/Fax

Practice location:
  • Phone: 423-942-3962
  • Fax: 423-942-6895
Mailing address:
  • Phone: 423-837-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN118414
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007705
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: