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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063883767 NPPES
South Carolina MEDICAID NP3611

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