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General NPI Number Information
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NPI Number | 1053640698
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Entity Type | Individual
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Provider Name | MICHAEL L PENDLETON SR. APRN
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Gender | Male
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1412 N RACE ST
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City | GLASGOW
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State | KY
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Zip | 42141-3473
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Country | US
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Telephone | 270-629-6333
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Fax | 270-629-6334
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Provider Business Mailing Address
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Address Line | PO BOX 906
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City | GLASGOW
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State | KY
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Zip | 42142-0906
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Country | US
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Telephone | 270-678-6333
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Fax | 270-678-7333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6291P
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License Number State | KY
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