MEDICARE: PENDLETON FAMILY CARE

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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1417324252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENDLETON FAMILY CARE

Provider Business Mailing Address
First Line	:	PO BOX 906
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42142-0906
Country	:	US
Telephone Number	:	270-678-6333
Fax Number	:	270-678-7333

Provider Business Practice Location Address
First Line	:	1412 N RACE ST
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-3473
Country	:	US
Telephone Number	:	270-629-6333
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MEMBER
Name	:	MICHAEL L PENDLETON SR.
Credential	:	APRN
Telephone Number	:	270-629-6333

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	10/09/2023

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Directions to “PENDLETON FAMILY CARE ” Practice Location

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