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NPI Code Detail

MEDICARE: MS. PAMELA JEANE SHRADER FNP

MEDICARE: MS. PAMELA JEANE SHRADER FNP
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
1207Q00000XFamily Medicine Physician120179WV

General Provider Information

NPI Number : 1932942646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA JEANE SHRADER FNP
Provider Business Mailing Address
First Line : 296 CARL J DR
Second Line :
City : BLUEFIELD
State : WV
Zip : 24701-7347
Country : US
Telephone Number : 304-809-4808
Fax Number :
Provider Business Practice Location Address
First Line : 150 MISTY LN
Second Line :
City : PRINCETON
State : WV
Zip : 24740-6462
Country : US
Telephone Number : 304-425-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2024
Last Update Date : 06/18/2024

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