Healthcare Provider Details

I. General information

NPI: 1639625205
Provider Name (Legal Business Name): MOLLIE KATHLEEN PENCE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLIE KATHLEEN GARDNER PMHNP, RN

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TAYLOR AVE
COLUMBUS OH
43203-1779
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-3760
  • Fax: 614-257-3750
Mailing address:
  • Phone: 614-257-3760
  • Fax: 614-257-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNP.019504
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201801169NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number350691
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201800505RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.019504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: