Active NPI
Pamela Sue Buckallew, ARNP
- Family Nurse Practitioner
- Jacksonville, FL
National Provider Identifier
1043279466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- ARNP1663702
- Practice address
- 4311 Salisbury Road
Jacksonville, FL 32216 - Phone
- (904) 332-4316
- Fax
- (904) 332-4339
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | ARNP1663702 | FL | Primary |
| Emergency Medicine Physician | 207P00000X | ARNP1663702 | FL |
Addresses
Primary practice location
4311 Salisbury Road
Jacksonville, FL 32216
Mailing address
4311 Salisbury Road
Jacksonville, FL 32216
Phone (904) 332-4316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 302869100 | Medicaid | FL |
Other names 1
- Pamela Sue Sims
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP1663702 | FL | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Florida Radiology Associates PA | Past | Accepting new patients |
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.
-
- Diagnostic Radiology Physician
- Milton, FL
- NPI 1396724654
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370995200000",
"number": "1043279466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4311 SALISBURY ROAD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32216",
"telephone_number": "904-332-4316",
"fax_number": "904-332-4339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4311 SALISBURY ROAD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32216",
"telephone_number": "904-332-4316",
"fax_number": "904-332-4339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKALLEW",
"first_name": "PAMELA",
"middle_name": "SUE",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2013-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "ARNP1663702",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "FL",
"license": "ARNP1663702",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "302869100",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PAMELA",
"last_name": "SIMS",
"middle_name": "SUE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.