Provider Demographics
NPI:1851643027
Name:DILLARD, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-3336
Mailing Address - Country:US
Mailing Address - Phone:870-780-6986
Mailing Address - Fax:870-780-6987
Practice Address - Street 1:634 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-3336
Practice Address - Country:US
Practice Address - Phone:870-780-6986
Practice Address - Fax:870-780-6987
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator