Pendergrass, Alicia
Pendergrass, Alicia is an individual health care provider with primary practice located at 1 Wellness Blvd Ste 203 , Irmo SC 29063-2873. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology, which is considered as her primary health care specialty. Pendergrass, Alicia can be contacted via phone (803) 749-9920.Contact Information
Primary practice address
1 Wellness Blvd Ste 203
Irmo SC 29063-2873
Phone: (803) 749-9920
Fax: (803) 749-9916
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology | 363LX0001X | 19686 | South Carolina |
Profile Details
NPI number | 1063883767 |
---|---|
LBN Legal business name | Pendergrass, Alicia |
Credentials | Family Nurse Practitioner (FNP) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Oct 7th, 2015 |
Last updated | Dec 20th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1063883767 | NPPES |
South Carolina | MEDICAID | NP3611 |
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