Provider Demographics
NPI:1740344431
Name:PENDLETON, TEKA YVETTE (CNP)
Entity type:Individual
Prefix:MS
First Name:TEKA
Middle Name:YVETTE
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 SUSSEX PLACE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8085
Mailing Address - Country:US
Mailing Address - Phone:614-208-7845
Mailing Address - Fax:
Practice Address - Street 1:2471 PERALTA ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-1703
Practice Address - Country:US
Practice Address - Phone:614-208-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.326258163W00000X
OHAPRN.CNP.023246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse