Provider Demographics
NPI:1053640698
Name:PENDLETON, MICHAEL L SR (APRN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:PENDLETON
Suffix:SR
Gender:M
Credentials:APRN
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Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0906
Mailing Address - Country:US
Mailing Address - Phone:270-678-6333
Mailing Address - Fax:270-678-7333
Practice Address - Street 1:1412 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3473
Practice Address - Country:US
Practice Address - Phone:270-629-6333
Practice Address - Fax:270-629-6334
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2023-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY6291P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily