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General NPI Number Information
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NPI Number | 1790479152
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Entity Type | Individual
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Provider Name | PAMELA PROCTOR CRISCITIELLO AGPCNP, MSN, RN, OCN
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Gender | Female
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 2215 E VILLA MARIA RD STE 110
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City | BRYAN
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State | TX
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Zip | 77802-2585
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Country | US
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Telephone | 979-776-2000
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Fax | 866-733-2572
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Provider Business Mailing Address
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Address Line | 812 PINE VALLEY DR
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City | COLLEGE STATION
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State | TX
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Zip | 77845-4460
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Country | US
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Telephone | 305-298-8973
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG05230129
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License Number State | TX
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