Provider Demographics
NPI:1154991917
Name:LATTIMORE, PAMELA BARD (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:BARD
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 MEDICAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6790
Practice Address - Country:US
Practice Address - Phone:919-742-6032
Practice Address - Fax:919-633-3018
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC93547363LF0000X
NC5014631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily