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NPI 1720129380

NPI 1720129380 : PAMELA L MYERS P.A.-C : NORTH WILKESBORO, NC

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General NPI Number Information
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    NPI Number           |    1720129380
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    Entity Type          |    Individual 
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    Provider Name        |    PAMELA L MYERS P.A.-C
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/08/2007
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    Last Update Date     |    09/04/2013
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Provider Practice Location Address
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    Address Line         |    702 13TH ST 
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    City                 |    NORTH WILKESBORO
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    State                |    NC
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    Zip                  |    28659-4075
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    Country              |    US
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    Telephone            |    336-667-5296
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    Fax                  |    336-667-0864
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Provider Business Mailing Address
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    Address Line         |    PO BOX 1348 
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    City                 |    NORTH WILKESBORO
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    State                |    NC
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    Zip                  |    28659-1348
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    Country              |    US
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    Telephone            |    336-667-5296
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    Fax                  |    336-667-0864
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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        |    363AM0700X
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    Taxonomy Name        |    Medical Physician Assistant
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    License Number       |    100774
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    License Number State |    NC
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Taxonomy #2
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    Taxonomy Code        |    363A00000X
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    Taxonomy Name        |    Physician Assistant
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    License Number       |    100774
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    License Number State |    NC
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