Provider Demographics
NPI:1902448608
Name:OWENS, PAMELA FAY RUDD (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:FAY RUDD
Last Name:OWENS
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 1:9165 BIG SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5915
Mailing Address - Country:US
Mailing Address - Phone:615-390-1310
Mailing Address - Fax:
Practice Address - Street 1:9165 BIG SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:TN
Practice Address - Zip Code:37037-5915
Practice Address - Country:US
Practice Address - Phone:615-390-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNNP000005550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily