Individual
SHELLY PENDERGRASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
217 RAILROAD AVE, DONALDSONVILLE, LA 70346-2527
(225) 473-3931
Mailing address
17075 FOX RIDGE DR, PRAIRIEVILLE, LA 70769-4834
(225) 235-6696
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
200820
LA
Other
Enumeration date
06/11/2015
Last updated
06/12/2015
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