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General NPI Number Information
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NPI Number | 1124885918
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Entity Type | Individual
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Provider Name | COLTON PENDLEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 3414 GOLDEN RD
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 903-939-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 SETON CENTER PKWY STE 115
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City | AUSTIN
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State | TX
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Zip | 78759-5753
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17878
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA17878
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License Number State | TX
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