Provider Demographics
NPI:1275208258
Name:PENDLETON, DEBRA K (LPN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9030
Mailing Address - Country:US
Mailing Address - Phone:270-792-1803
Mailing Address - Fax:
Practice Address - Street 1:131 WAGON TRL
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9030
Practice Address - Country:US
Practice Address - Phone:270-792-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2035466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse