Pamela Ann Smith, NP – Licensed Practical Nurse

Key facts

NPI: 1003907866
Entity type: Individual (NPI type 1)
Primary specialty: Licensed Practical Nurse 164W00000X
License: 166670 (MA)
Practice address: 59 Pheasant Way
Centerville, MA 02632-3221
Phone: (508) 790-7557
Fax: (508) 790-2331
NPI assigned: Sep 27, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Sisters of Providence Care CTRS Inc Adult Care Home Facility · Holyoke, MA · NPI 1790776698

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Sisters of Providence Care CTRS Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Licensed Practical Nurse	164W00000X	166670	MA	Yes

Addresses

Primary practice location

59 Pheasant Way
Centerville, MA 02632-3221

Mailing address

59 Pheasant Way
Centerville, MA 02632-3221
Phone (508) 790-7557

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003907866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 PHEASANT WAY",
            "city": "CENTERVILLE",
            "state": "MA",
            "postal_code": "026323221",
            "telephone_number": "508-790-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 PHEASANT WAY",
            "city": "CENTERVILLE",
            "state": "MA",
            "postal_code": "026323221",
            "telephone_number": "508-790-7557",
            "fax_number": "508-790-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "PAMELA",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MA",
            "license": "166670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, MA

All providers in Centerville, MA · Licensed Practical Nurse in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.