Provider Demographics
NPI:1144902958
Name:MABEN-REED, PAMELA KATE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KATE
Last Name:MABEN-REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HAMER RD
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-6905
Mailing Address - Country:US
Mailing Address - Phone:901-567-6834
Mailing Address - Fax:
Practice Address - Street 1:89 HAMER RD
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-6905
Practice Address - Country:US
Practice Address - Phone:901-567-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0062626895343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)