Provider Demographics
NPI:1962019653
Name:MCGOWAN, PAMALA DENIESE (APRN)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:DENIESE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 FM 2547
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-5230
Mailing Address - Country:US
Mailing Address - Phone:903-391-7900
Mailing Address - Fax:
Practice Address - Street 1:600 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3603
Practice Address - Country:US
Practice Address - Phone:254-562-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716074163W00000X
TX1094912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse