Provider Demographics
NPI:1720828718
Name:CRISP, PAMELA (AUD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:CRISP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2815 NEUSE BLVD APT 16
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2836
Mailing Address - Country:US
Mailing Address - Phone:252-497-3717
Mailing Address - Fax:
Practice Address - Street 1:2040 LOUISVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1249
Practice Address - Country:US
Practice Address - Phone:270-746-7816
Practice Address - Fax:270-746-7877
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002146231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist