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NPI Code Detail

MEDICARE: GRACE ANN PENDERGRAFT

MEDICARE: GRACE ANN PENDERGRAFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician106S00000XTX

General Provider Information

NPI Number : 1164354247
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ANN PENDERGRAFT
Provider Business Mailing Address
First Line : 7329 FM 2086
Second Line :
City : TEMPLE
State : TX
Zip : 76501-3698
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15140 BADGER RANCH BLVD
Second Line :
City : WACO
State : TX
Zip : 76712-8983
Country : US
Telephone Number : 254-545-2674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ GRACE ANN PENDERGRAFT ” Practice Location

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