Pamela Michelle Nisen, ADVANCED PRACTICE NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Hahira, GA
NPI 1497577480 · NPPES record last updated Oct 30, 2024
Key facts
- NPI
- 1497577480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- RN224309 (GA)
- Practice address
- 4948 Hatfield Cir
Hahira, GA 31632-2671 - Phone
- (229) 563-0800
- NPI assigned
- Oct 30, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN224309 | GA | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN224309 | GA | Yes |
Addresses
Primary practice location
4948 Hatfield Cir
Hahira, GA 31632-2671
Mailing address
4948 Hatfield Cir
Hahira, GA 31632
Phone (229) 563-0800
Other providers in Hahira, GA
- Lequinnaka L Mims
- Kristina Rae Molina-Croes
- Michayla H Moody
- Pamela Marie Moore
- Britney Heather Nash
- Orchard Hospice, Inc.
- Alyssa Pate
- Sarah Merree Peek
- Whitney Pierce
- Play on Words Therapy Services LLC
All providers in Hahira, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2024. 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.