Basic Information
| Provider Information | |||||||||
| NPI: | 1396796348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYERS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 WOODLAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT SCOTT | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667018797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202238040 | ||||||||
| FaxNumber: | 6202238002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 75716 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.