Healthcare Provider Details

I. General information

NPI: 1154502532
Provider Name (Legal Business Name): PAMELA BEAVER WELLS DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA SUE BEAVER FNP-BC

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HOLSTON RD
WYTHEVILLE VA
24382-4448
US

IV. Provider business mailing address

255 HOLSTON RD
WYTHEVILLE VA
24382-4448
US

V. Phone/Fax

Practice location:
  • Phone: 276-227-0206
  • Fax:
Mailing address:
  • Phone: 276-227-0206
  • Fax: 276-227-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN0000012879
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: