Provider Demographics
NPI:1932942646
Name:SHRADER, PAMELA JEANE (FNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEANE
Last Name:SHRADER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CARL J DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-7347
Mailing Address - Country:US
Mailing Address - Phone:304-809-4808
Mailing Address - Fax:
Practice Address - Street 1:150 MISTY LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-6462
Practice Address - Country:US
Practice Address - Phone:304-425-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine