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General NPI Number Information
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NPI Number | 1497147318
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Entity Type | Individual
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Provider Name | MONIQUE PENDLETON
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Gender | Female
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 4635 HIGHWAY 80 E
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City | PEARL
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State | MS
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Zip | 39208-4226
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Country | US
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Telephone | 601-502-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 BAILEY AVE STE 7
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City | JACKSON
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State | MS
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Zip | 39213-6905
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Country | US
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Telephone | 601-502-3009
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Fax | 769-251-1503
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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 | F0215192
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License Number State | MS
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