Basic Information
| Provider Information | |||||||||
| NPI: | 1396857223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUCKEY | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 399 COUNTRY MANOR | ||||||||
| Address2: | |||||||||
| City: | DEFUNIAK SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508928073 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3686 US HWY 331 S | ||||||||
| Address2: | COPE CENTER INC | ||||||||
| City: | DEFUNIAK SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508928045 | ||||||||
| FaxNumber: | 8508928039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.