MEDICARE: MS. PAMELA LYNN HERBIG WALL PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	533187	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	289390	NC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024178121	VA

General Provider Information

NPI Number	:	1033386446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA LYNN HERBIG WALL PMHNP

Provider Business Mailing Address
First Line	:	1340 WALTER REED RD STE 202
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4451
Country	:	US
Telephone Number	:	910-504-3506
Fax Number	:	910-504-3507

Provider Business Practice Location Address
First Line	:	1340 WALTER REED RD STE 202
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4451
Country	:	US
Telephone Number	:	910-504-3506
Fax Number	:	910-504-3507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	11/13/2025

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