Provider Demographics
NPI:1639625205
Name:PENCE, MOLLIE KATHLEEN (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:KATHLEEN
Last Name:PENCE
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:MRS
Other - First Name:MOLLIE
Other - Middle Name:KATHLEEN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP, RN
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-257-3760
Mailing Address - Fax:614-257-3750
Practice Address - Street 1:181 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1779
Practice Address - Country:US
Practice Address - Phone:614-257-3760
Practice Address - Fax:614-257-3750
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019504364SP0808X, 363L00000X
OR201801169NP-PP363LP0808X
OH350691163W00000X
OR201800505RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMG394-7833OtherDEA
OHXG3947833OtherDEA