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General NPI Number Information
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NPI Number | 1437966108
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Entity Type | Individual
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Provider Name | KELLY MCCOLLUM PENDLETON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 3702 2ND AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-7408
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Country | US
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Telephone | 706-507-9209
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Fax |
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Provider Business Mailing Address
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Address Line | 33 GRIZZLY CT
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City | FORTSON
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State | GA
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Zip | 31808-4556
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Country | US
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Telephone | 706-577-8606
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN191030
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License Number State | GA
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