Provider Demographics
NPI:1487625836
Name:FAULKNER, PAMELA ROGERS (APRN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ROGERS
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MARIE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3721 WESTERRE PKWY
Mailing Address - Street 2:SUITE 7F
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1332
Mailing Address - Country:US
Mailing Address - Phone:804-269-4916
Mailing Address - Fax:804-918-6114
Practice Address - Street 1:3721 WESTERRE PKWY
Practice Address - Street 2:SUITE 7F
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1332
Practice Address - Country:US
Practice Address - Phone:804-269-4916
Practice Address - Fax:804-918-6114
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164150363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health