Provider Demographics
NPI:1417445883
Name:PENDERGRAFT, ADREANNA MEGAN
Entity Type:Individual
Prefix:MRS
First Name:ADREANNA
Middle Name:MEGAN
Last Name:PENDERGRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ADREANNA
Other - Middle Name:MEGAN
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2153 E JOYCE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5285
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-587-9392
Practice Address - Street 1:3715 N BUSINESS DR STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5287
Practice Address - Country:US
Practice Address - Phone:870-280-8776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator