Individual
ALICIA PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1 WELLNESS BLVD STE 203, IRMO, SC 29063-2873
(803) 749-9920
(803) 749-9916
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 749-9920
(803) 749-9916
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
19686
SC
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
19686
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3611
—
SC
Enumeration date
10/07/2015
Last updated
08/18/2025
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