Healthcare Provider Details

I. General information

NPI: 1992633705
Provider Name (Legal Business Name): KIM E PENDER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12343 ACAPULCO AVE
PALM BEACH GARDENS FL
33410-2201
US

IV. Provider business mailing address

12343 ACAPULCO AVE
PALM BEACH GARDENS FL
33410-2201
US

V. Phone/Fax

Practice location:
  • Phone: 207-232-9493
  • Fax:
Mailing address:
  • Phone: 207-232-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11045747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: