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NPI Code Detail

MEDICARE: MRS. KATHLEEN BYRNE PENDERGAST PNP

MEDICARE: MRS. KATHLEEN BYRNE PENDERGAST PNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner381846NY

General Provider Information

NPI Number : 1093803421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN BYRNE PENDERGAST PNP
Provider Business Mailing Address
First Line : 500 WEBSTER AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-4732
Country : US
Telephone Number : 585-482-9290
Fax Number : 585-324-5812
Provider Business Practice Location Address
First Line : 500 WEBSTER AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-4732
Country : US
Telephone Number : 585-482-9290
Fax Number : 585-324-5812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 10/07/2011

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