Provider Demographics
NPI:1134275019
Name:MILAM, PAMELA SUZETTE (CNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUZETTE
Last Name:MILAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:SUZETTE
Other - Middle Name:M
Other - Last Name:RENFROW (PREVIOUSLY HUNTER)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:9120 NEW HOME RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237
Mailing Address - Country:US
Mailing Address - Phone:731-571-1395
Mailing Address - Fax:731-587-3460
Practice Address - Street 1:209 WEST STATE LINE RD.
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257
Practice Address - Country:US
Practice Address - Phone:731-479-2112
Practice Address - Fax:731-479-2116
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4086343OtherBCBS
TNP00168718OtherRAILROAD MEDICARE
TN3341823Medicare ID - Type Unspecified
R88502Medicare UPIN
TN3341823Medicare ID - Type Unspecified