Pamela Renne Wallen, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2001013763 Issued in MO

Practice address

1580 W Columbia St
Farmington, MO 63640-3512

Phone

(573) 760-1365

Fax

(573) 760-0354

NPI assigned

Oct 26, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392940800000",
    "number": "1326123225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 W COLUMBIA ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403512",
            "telephone_number": "573-760-1365",
            "fax_number": "573-760-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 W COLUMBIA ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403512",
            "telephone_number": "573-760-1365",
            "fax_number": "573-760-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "PAMELA",
        "middle_name": "RENNE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2014-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2001013763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "167106",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495281511",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7994334",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "614085",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Melissa A Walker
• Nick S Walker
• Steven Vern Walker, L.P.C.
• Amy Dianna Wallen, FNP
• Sheila Estelle Walton
• Miranda Wampler
• Breah Wheeler Ward, PLPC
• Lois E Ward, DC
• Mark E Wardlow Jr., LPC

• Clinical Psychologist in Farmington, MO
• Providers in Farmington, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.