Provider Demographics
NPI:1871698563
Name:WOMACK, PAMELA JO (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:WOMACK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 RINGSBY CT
Mailing Address - Street 2:UNIT 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-4922
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:720-598-0440
Practice Address - Street 1:3455 RINGSBY CT
Practice Address - Street 2:UNIT 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-4922
Practice Address - Country:US
Practice Address - Phone:303-500-1518
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN00000644212086S0127X
CO4539363LA2100X
FLAPRN9474400363L00000X
GARN290640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care