Provider Demographics
NPI:1093803421
Name:PENDERGAST, KATHLEEN BYRNE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:BYRNE
Last Name:PENDERGAST
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4732
Mailing Address - Country:US
Mailing Address - Phone:585-482-9290
Mailing Address - Fax:585-324-5812
Practice Address - Street 1:500 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4732
Practice Address - Country:US
Practice Address - Phone:585-482-9290
Practice Address - Fax:585-324-5812
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381846363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics