Provider Demographics
NPI:1902450281
Name:SHIRLEY, PAMELA (CRNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 S VALLEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35961-3263
Mailing Address - Country:US
Mailing Address - Phone:256-524-3090
Mailing Address - Fax:256-524-2885
Practice Address - Street 1:52 S VALLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35961-3263
Practice Address - Country:US
Practice Address - Phone:256-524-3090
Practice Address - Fax:256-524-2885
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine