Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 308544 | NY |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN181956 | GA |
NPI | 1013404292 |
---|---|
Provider Name | Pamela Renee Bethel-Wilson |
First Address | Douglasville, GA 30134-6634 |
Second Address | Dallas, TX 75244-5074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 13/04/2018 |