Provider Demographics
NPI:1043214562
Name:GUNNELL, PAMELA C (FNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:GUNNELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2437
Mailing Address - Country:US
Mailing Address - Phone:931-526-4004
Mailing Address - Fax:931-526-4014
Practice Address - Street 1:67 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3371
Practice Address - Country:US
Practice Address - Phone:931-526-4004
Practice Address - Fax:931-526-4014
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN93501363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN408-6954OtherBCBS
3905055Medicare PIN
TN408-6954OtherBCBS