Healthcare Provider Details

I. General information

NPI: 1194586396
Provider Name (Legal Business Name): CHASITY PENDLETON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONARCH ST STE 100
LEXINGTON KY
40513-1899
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8421
  • Fax: 859-276-2433
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-276-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4015539
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: