Provider Demographics
NPI:1073884888
Name:PENDLETON, ANDREA (RN, MS, CPNP)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:RN, MS, CPNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:STICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MS, CPNP
Mailing Address - Street 1:2222 WELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3924
Mailing Address - Country:US
Mailing Address - Phone:214-559-5000
Mailing Address - Fax:214-443-7309
Practice Address - Street 1:2222 WELBORN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3924
Practice Address - Country:US
Practice Address - Phone:214-559-5000
Practice Address - Fax:214-443-7309
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX566807363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics