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General NPI Number Information
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NPI Number | 1326318205
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Entity Type | Individual
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Provider Name | MRS. PAMELA ANN HERVEY
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Gender | Female
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 475 MCLIN CIR
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City | FLORENCE
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State | MS
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Zip | 39073-7939
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Country | US
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Telephone | 601-845-6651
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Fax | 601-845-0230
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Provider Business Mailing Address
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Address Line | 475 MCLIN CIR
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City | FLORENCE
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State | MS
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Zip | 39073-7939
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Country | US
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Telephone | 601-845-6651
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Fax | 601-845-0230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 04129817
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 08700721
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License Number State | MS
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