DR. PAMELA RENNE WALLEN (NPI# 1326123225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326123225 |
| Entity Type | Individual |
| Full Name | DR. PAMELA RENNE WALLEN |
| Credential | PSY.D. |
| Practice Address |
1580 W Columbia St Farmington MO 63640-3512 |
| Practice Telephone | 5737601365 |
| Practice Fax Number | 5737600354 |
| Mailing Telephone | 5737601365 |
| Mailing Fax Number | 5737600354 |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2014-02-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
2001013763 | MO | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | BLUE CROSS BLUE SHIELD | 167106 | 01 |
| MO | HEALTH LINK | 614085 | 01 |
| MO | AETNA | 7994334 | 01 |
| MO | 495281511 | 05 |
| Street Address |
1580 W COLUMBIA ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-3512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992745277 | St. Louis Jc Vamc | Clinic/Center | 1580 W Columbia St, Farmington, MO 63640-3512 | 2006-06-07 |
| 1982019857 | Ashley Marie Merritt | Pharmacist | 1580 W Columbia St, Farmington, MO 63640-3512 | 2014-06-30 |
| 1326376260 | Shawn Phillip Lee | Social Worker | 1580 W Columbia St, Farmington, MO 63640-3512 | 2009-12-04 |
| 1548595499 | Marilyn C Shoumake | Counselor | 1580 W Columbia St, Farmington, MO 63640-3512 | 2009-10-09 |
| 1497871776 | Daniel Jeremy Cuneio | Social Worker | 1580 W Columbia St, Farmington, MO 63640-3512 | 2007-03-21 |
| 1982621405 | Melinda Ann Barton | Nurse Practitioner | 1580 W Columbia St, Farmington, MO 63640-3512 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700275682 | Talya Steinberg | Psychologist | 4109 Old Mission Rd, Farmington, NM 87401-2346 | 2015-01-15 |
| 1447506621 | Alisa Anne O'riley | Psychologist | 1130 Willow Brook Bnd, Farmington, NY 14425-9064 | 2012-07-25 |
| 1306144944 | Michael James Moravecek | Psychologist | 24 Woods Run, Farmington, CT 06032-2731 | 2011-03-07 |
| 1073818175 | Diane W Williams Psyd PC D/b/a Integrative Mental Health | Psychologist | 3001 Northridge Dr Ste A, Farmington, NM 87401-2084 | 2011-01-20 |
| 1346574589 | Amy C Beaulieu | Psychologist | 3 Forest Park Dr, Farmington, CT 06032-1468 | 2009-09-21 |
| 1164665253 | Sandra Scantling | Psychologist | 778 Farmington Ave, Farmington, CT 06032-2342 | 2009-04-20 |
| 1952554040 | Aaron Michael Shepherd | Psychologist | 38345 West 10 Mile Road Suite 150, Farmington, MI 48335 | 2008-11-03 |
| 1679724256 | Michaelene Renee Ruhl | Psychologist | 33335 Grand River Ave, Farmington, MI 48336-3194 | 2008-10-01 |
| 1982869152 | Kimberly S.b. Corey | Psychologist | 1 Oakland Ave, Farmington, CT 06032-1720 | 2008-07-27 |
| 1346256591 | David Coron | Psychologist | 6137 County Road 41, Farmington, NY 14425-8931 | 2006-07-31 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on DR. PAMELA RENNE WALLEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.