Individual provider Active NPI

Pamela Sue Myers, RN

  • Registered Nurse
  • Osceola, AR
National Provider Identifier
1790908614
Registry record updated May 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R064205 Issued in AR
Practice address
3201 W Keiser Ave
Osceola, AR 72370-3467
Phone
(870) 622-0592
Fax
(870) 622-0782
NPI assigned
Apr 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Registered Nurse 163WC0400X R64205 AR
Registered Nurse 163W00000X R064205 AR Primary

Addresses

Primary practice location

3201 W Keiser Ave
Osceola, AR 72370-3467

Mailing address

1815 Pleasant Grove Rd
Jonesboro, AR 72401-7870
Phone (870) 933-6886

Other identifiers 1

IdentifierTypeStateIssuer
173647795MedicaidAR

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)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R064205ARMDRegistered Nurse
R64205ARMDCase Management Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526515200000",
    "number": "1790908614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W KEISER AVE",
            "city": "OSCEOLA",
            "state": "AR",
            "postal_code": "723703467",
            "telephone_number": "870-622-0592",
            "fax_number": "870-622-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "PAMELA",
        "middle_name": "SUE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2018-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "AR",
            "license": "R64205",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R064205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173647795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Osceola, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.