Provider Demographics
NPI:1730502741
Name:VINTON, PAMELA KEY (BSN, BA, RN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KEY
Last Name:VINTON
Suffix:
Gender:F
Credentials:BSN, BA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4802
Mailing Address - Country:US
Mailing Address - Phone:817-321-4867
Mailing Address - Fax:817-321-4818
Practice Address - Street 1:1101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4802
Practice Address - Country:US
Practice Address - Phone:817-321-4867
Practice Address - Fax:817-321-4818
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707800261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health