Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Phokham Mike Sourivanh, PA-C

Individual provider Military Health Care Provider · NPI 1972022762

Mr. Phokham Mike Sourivanh, PA-C is a Military Health Care Provider in Pensacola, Florida. Works from 3 locations. Registered with an NPI since 2017.

In the registry since
2017
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

Nmrtc Pensacola 6000 West Highway 98
Pensacola, FL 32512-0001
Phone: (901) 874-6081
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • Camp Pendleton, Apo, AP 92055 — (760) 725-1288
  • 34800 Bob Wilson Dr, San Diego, CA 92134-1098 — (619) 532-6400

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X
Military Health Care Provider Taxonomy 171000000X

Record details

NPI number1972022762
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 13, 2017
Last updated in NPPESJune 24, 2025
Certification dateJune 24, 2025

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