=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093630345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ICYM HEALTH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 PARKVIEW LN
-----------------------------------------------------
City | REIDSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27320-9448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-621-2065
-----------------------------------------------------
Fax | 540-621-2065
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 PARKVIEW LN
-----------------------------------------------------
City | REIDSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27320-9448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-621-2065
-----------------------------------------------------
Fax | 540-621-2065
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAMELA JEAN SCHOLL
-----------------------------------------------------
Credential | AGACNP-BC
-----------------------------------------------------
Telephone | 540-621-2065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------