Healthcare Provider Details

I. General information

NPI: 1518483023
Provider Name (Legal Business Name): PAMELA R CLARKE MSN, RN, CHFN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CHARLES H DIMMOCK PKWY STE 100
COLONIAL HEIGHTS VA
23834-2986
US

IV. Provider business mailing address

13000 RIVERS BEND BLVD STE D
CHESTER VA
23836-8632
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-5888
  • Fax: 804-526-5401
Mailing address:
  • Phone: 804-571-5106
  • Fax: 804-530-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174961
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: