Provider Demographics
NPI:1528067980
Name:DAVIS, PAMALA D (RNCS,FNP)
Entity type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RNCS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27779 280 ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-8103
Mailing Address - Country:US
Mailing Address - Phone:660-686-2739
Mailing Address - Fax:
Practice Address - Street 1:100 E CASS ST
Practice Address - Street 2:
Practice Address - City:ROCK PORT
Practice Address - State:MO
Practice Address - Zip Code:64482-1528
Practice Address - Country:US
Practice Address - Phone:660-744-5361
Practice Address - Fax:660-744-2247
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO077296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK94A295Medicare ID - Type UnspecifiedKANSAS CITY MO/TOPEKA
MOK62A295Medicare ID - Type UnspecifiedKANSAS CITY MO/TOPEKA
P04175Medicare UPIN