Pamela Lynn Davis, PAC
Individual provider Active NPI Physician Assistant · Southaven, MS
NPI 1275544397 · NPPES record last updated Sep 8, 2011
Key facts
- NPI
- 1275544397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA0818 (TN)
- Practice address
- 122 Airways PL
Southaven, MS 38671-5872 - Phone
- (662) 349-9990
- Fax
- (662) 349-2620
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040601001194 | TN | Practitioner - Physician Assistant | 1355323700 | Reassigns benefits to 2 organizations |
| I20160913002063 | OH | Practitioner - Physician Assistant | 1355323700 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0818 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tennessee Em-I Medical Services, PC | Past | Accepting new patients | |
| Tennessee Em-I Medical Services, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00099 | MS | |
| Physician Assistant | 363A00000X | PA0818 | TN | Yes |
Addresses
Primary practice location
122 Airways PL
Southaven, MS 38671-5872
Mailing address
122 Airways PL
Southaven, MS 38671-5872
Phone (662) 349-9990
Other providers in Southaven, MS
- Gabrielle Grace Davis
- Kelli H. Davis
- Kimberly Davis
- Laura Elizabeth Davis
- Michelle Davis
- Shaniqua Davis
- Shirley T Davis
- Tabitha Elizabeth Davis
- Radhi Daya
- DC Direct
All providers in Southaven, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.