=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538143201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA GREGORY PRIEST NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 02/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 PHILIP ROTH ST SUITE 5A
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-1393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-599-6333
-----------------------------------------------------
Fax | 757-591-7261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 856 J CLYDE MORRIS BLVD SUITE A
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-594-4006
-----------------------------------------------------
Fax | 757-534-5190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024164006
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------