MR. PHOKHAM MIKE SOURIVANH PA-C
NPI 1972022762
Physician Assistant - Medical in Pensacola, FL

Q: What is Phokham Sourivanh's NPI number?

The NPI number for Phokham Sourivanh is 1972022762. It was assigned to this individual provider in the NPPES registry on September 13, 2017.

Q: What is Phokham Sourivanh's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Phokham Sourivanh was last updated on June 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 13, 2017

NMRTC PENSACOLA 6000 WEST HIGHWAY 98, PENSACOLA, FL 32512(901) 874-6081 Get Directions Write a Review

NPPES record last updated: June 24, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 24, 2025, Apr 21, 2022, Feb 27, 2019 and 1 more (4 updates tracked since 2017).

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About Mr. Phokham Mike Sourivanh Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. PHOKHAM MIKE SOURIVANH PA-C (NPI 1972022762) is an individual medical provider in Pensacola, Florida and active in the NPI registry since September 2017. He maintains 2 additional practice locations.

NPPES Registry Identity

NPI1972022762

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameMR. PHOKHAM MIKE SOURIVANHCredential: PA-C

Location AddressNMRTC PENSACOLA 6000 WEST HIGHWAY 98Pensacola, FL 32512-0001

Mailing AddressCamp PendletonApo, AP 92055

Phone(901) 874-6081

Sole ProprietorNo

Enumeration DateSeptember 13, 2017

Last NPPES UpdateJune 24, 20254 updates tracked since enumeration

NPPES CertifiedJune 24, 2025

✔ NPI 1972022762 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

Also ListedMilitary Health Care ProviderTaxonomy 171000000X

NMRTC PENSACOLA 6000 WEST HIGHWAY 98, Pensacola, FL 32512

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Secondary Practice Locations 2

Location 134800 Bob Wilson DrSan Diego, CA 92134-1098 · Phone (619) 532-6400

Location 2Camp PendletonAPO, AP 92055 · Phone (760) 725-1288

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phokham Sourivanh's NPI number?

The NPI number for Phokham Sourivanh is 1972022762. It was assigned to this individual provider in the NPPES registry on September 13, 2017.

Where is Phokham Sourivanh located?

Phokham Sourivanh practices at Nmrtc Pensacola 6000 West Highway 98, Pensacola, FL 32512. The listed phone number is (901) 874-6081.

What is Phokham Sourivanh's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Phokham Sourivanh was last updated on June 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.