Provider Demographics
NPI:1386417939
Name:MACEDONIA, PAMELA (APRN PMHNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MACEDONIA
Suffix:
Gender:F
Credentials:APRN PMHNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 MASTER ST
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1065
Mailing Address - Country:US
Mailing Address - Phone:606-280-4000
Mailing Address - Fax:833-222-3797
Practice Address - Street 1:1013 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1065
Practice Address - Country:US
Practice Address - Phone:606-280-4000
Practice Address - Fax:833-222-3797
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health