Provider Demographics
NPI:1962831628
Name:PENDERGHEST, CHRISTINA M (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:PENDERGHEST
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:KUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3803 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2333
Mailing Address - Country:US
Mailing Address - Phone:484-337-1667
Mailing Address - Fax:
Practice Address - Street 1:120 VALLEY GREEN LN
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2079
Practice Address - Country:US
Practice Address - Phone:484-324-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN635057163W00000X
PASP013278363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse