Healthcare Provider Details

I. General information

NPI: 1679435945
Provider Name (Legal Business Name): PAMELA RENEE ROSE NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 BEN BOLT AVE
TAZEWELL VA
24651-5386
US

IV. Provider business mailing address

7644 BURKES GARDEN RD
TAZEWELL VA
24651-8528
US

V. Phone/Fax

Practice location:
  • Phone: 276-988-8850
  • Fax:
Mailing address:
  • Phone: 276-988-8863
  • Fax: 276-988-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0001154149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: