Provider Demographics
NPI:1336902949
Name:PENDLETON, TRAYDACIA KIARA (CNM, MSN)
Entity Type:Individual
Prefix:MS
First Name:TRAYDACIA
Middle Name:KIARA
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:670 DOWNEY GREEN ST APT 106
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3070
Mailing Address - Country:US
Mailing Address - Phone:901-395-4763
Mailing Address - Fax:
Practice Address - Street 1:4000 COLISEUM DR STE 280
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5974
Practice Address - Country:US
Practice Address - Phone:757-827-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife