Provider Demographics
NPI:1427663863
Name:PENDLETON, CHELSEA MEGAN (APRN)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MEGAN
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 REDBIRD LN
Mailing Address - Street 2:
Mailing Address - City:ULMAN
Mailing Address - State:MO
Mailing Address - Zip Code:65083-2131
Mailing Address - Country:US
Mailing Address - Phone:573-375-0195
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-302-2715
Practice Address - Fax:573-302-2713
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020030162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420101287Medicaid