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NPI Code Detail

MEDICARE: CARLINA LOPEZ PENDON FNP-C

MEDICARE: CARLINA LOPEZ PENDON FNP-C
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
1363LF0000XFamily Nurse Practitioner10717TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34176928OTHERTNBCBS TENNESSEE

General Provider Information

NPI Number : 1831150549
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLINA LOPEZ PENDON FNP-C
Provider Business Mailing Address
First Line : 1508 TOMBRAS AVENUE
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-2720
Country : US
Telephone Number : 423-867-4969
Fax Number : 423-867-4971
Provider Business Practice Location Address
First Line : 1508 TOMBRAS AVENUE
Second Line :
City : EAST RIDGE
State : TN
Zip : 37412-2720
Country : US
Telephone Number : 423-867-4969
Fax Number : 423-867-4971
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 03/03/2015

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Practice Location Address:
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1457315848 — DR. JUDITH J BOGGESS M.D.
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1689620999 — DR. RANDY ROBERT HEISSER MD
Practice Location Address:
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Practice Fax: 423-867-4971
1881634483 — DR. BRUCE ALLEN PENDLEY MD
Practice Location Address:
1508 TOMBRAS AVE
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1780627240 — DR. SAUNDRA ANNETTE WILLIAMS MD
Practice Location Address:
1508 TOMBRAS AVE
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1174567416 — MS. ARDYCE JANE RIDOLFO MSN,D.PHIL, GNP, FNP
Practice Location Address:
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37412-2720
Practice Phone: 423-867-4969
Practice Fax: 423-867-4971

Directions to “ CARLINA LOPEZ PENDON FNP-C” Practice Location

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