Healthcare Provider Details

I. General information

NPI: 1053533463
Provider Name (Legal Business Name): AMBER L PENDLETON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3440
  • Fax: 502-588-3441
Mailing address:
  • Phone: 502-588-3440
  • Fax: 502-588-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: