Provider Demographics
NPI:1710308382
Name:PENDERGRASS, JUDITH JANELL (RD)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:JANELL
Last Name:PENDERGRASS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:JANELL
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4207 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3621
Mailing Address - Country:US
Mailing Address - Phone:615-298-4840
Mailing Address - Fax:
Practice Address - Street 1:607 MEDICAL ARTS BUILDING
Practice Address - Street 2:1211 21ST AVENUE, SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1320
Practice Address - Country:US
Practice Address - Phone:615-936-3952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered