Healthcare Provider Details

I. General information

NPI: 1740344431
Provider Name (Legal Business Name): TEKA YVETTE PENDLETON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 PERALTA ST
OAKLAND CA
94607-1703
US

IV. Provider business mailing address

2988 SUSSEX PLACE DR
GROVE CITY OH
43123-8085
US

V. Phone/Fax

Practice location:
  • Phone: 614-208-7845
  • Fax:
Mailing address:
  • Phone: 614-208-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.326258
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.023246
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: