Provider Demographics
NPI:1043969769
Name:PENDERGRASS, ALLYSON (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 MACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-1729
Mailing Address - Country:US
Mailing Address - Phone:281-896-6512
Mailing Address - Fax:
Practice Address - Street 1:845 TEXAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-2858
Practice Address - Country:US
Practice Address - Phone:281-896-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered