IndividualActive
Phokham Sourivanh, PA-C
NPI 1972022762 · Medical Physician Assistant · Pensacola, FL
Provider details
- NPI number
- 1972022762
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Military Health Care Provider171000000X
Other Service Providers
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
3 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Nmrtc Pensacola 6000 West Highway 98
Pensacola, FL 32512-0001
Phone: (901) 874-6081
Street-level locationGet directions
Mailing address
Camp Pendleton
Apo, AP 92055
Additional practice locations (2)
- Camp PendletonApo, AP 92055Phone: (760) 725-1288
- 34800 Bob Wilson DrSan Diego, CA 92134-1098Phone: (619) 532-6400
Registry dates
- Enumerated
- 2017-09-13
- Last updated
- 2025-06-24
- Certified
- 2025-06-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.