Individual
DR. PAMELA KAYE HARSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1890 LYDA AVE, SUITE 103, BOWLING GREEN, KY 42104-5829
(270) 904-6160
(270) 904-6165
Mailing address
1890 LYDA AVE, SUITE 103, BOWLING GREEN, KY 42104-5829
(270) 904-6160
(270) 904-6165
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25936
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197280
ANTHEM BCBS
KY
01
—
1157737
PASSPORT MEDICAID
KY
01
—
1467280
UMWA
KY
01
—
250005380
RR MEDICARE
KY
05
—
64259369
—
KY
01
—
8122
KY DEPT OF WC
KY
Enumeration date
11/30/2006
Last updated
10/26/2009
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