Healthcare Provider Details

I. General information

NPI: 1134267560
Provider Name (Legal Business Name): PAMELLA PATRICIA DRYSDALE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 MESA DR
KILLEEN TX
76542-8411
US

IV. Provider business mailing address

3600 DARNALL LOOP CARL R. DARNALL ARMY MEDICAL CENTER
FT HOOD TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 254-287-6789
  • Fax: 254-288-9383
Mailing address:
  • Phone: 254-287-6789
  • Fax: 254-288-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number493101-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: