Provider Demographics
NPI:1063590305
Name:EDWARDS, PAMALA J (PA)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:700 FLOURNOY RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4003
Practice Address - Country:US
Practice Address - Phone:361-664-1417
Practice Address - Fax:361-664-3218
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02621363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063476801Medicaid
TX312414101Medicaid
TX8J3360OtherMEDICARE PARTB FOR COMMUNITY ACTION
TX8J3360OtherMEDICARE PARTB FOR COMMUNITY ACTION