Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 14561 | CA |
NPI | 1023038593 |
---|---|
Provider Name | Pamela N Kingery |
First Address | Saint Jo, TX 76265-0322 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 05/01/2012 |