Provider Demographics
NPI:1205979259
Name:DEVORE, PAMELA S
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:DEVORE
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 1:445 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-9648
Mailing Address - Country:US
Mailing Address - Phone:828-321-2657
Mailing Address - Fax:828-321-2657
Practice Address - Street 1:445 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-9648
Practice Address - Country:US
Practice Address - Phone:828-321-2657
Practice Address - Fax:828-321-2657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2119251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600809Medicaid