Individual
MRS. TRISTA LEE PENDERGRAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 428-2501
(360) 428-2596
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60330625
WA
Other
Enumeration date
01/17/2013
Last updated
04/16/2013
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