Provider Demographics
NPI:1447546452
Name:WINSTON, PAMELA S (FNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WINSTON
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 1:124 RAY LOCHALA RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-4542
Mailing Address - Country:US
Mailing Address - Phone:870-364-0590
Mailing Address - Fax:870-364-3811
Practice Address - Street 1:124 RAY LOCHALA RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4542
Practice Address - Country:US
Practice Address - Phone:870-364-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06506363LF0000X
ARA03697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191823758Medicaid
LA2179896Medicaid