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General NPI Number Information
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NPI Number | 1790828739
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Entity Type | Individual
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Provider Name | COLLEEN A. PENDERGRASS P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6124 W PARKER RD SUITE 536
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City | PLANO
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State | TX
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Zip | 75093-8122
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Country | US
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Telephone | 972-943-8440
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Fax | 972-943-8348
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Provider Business Mailing Address
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Address Line | PO BOX 35629
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City | DALLAS
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State | TX
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Zip | 75235-0629
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Country | US
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Telephone | 214-424-2213
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Fax | 214-231-2170
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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 | PA00932
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License Number State | TX
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