Individual
BRIANNA MICHELLE PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1325 E FORTIFICATION ST, JACKSON, MS 39202-2442
(601) 354-4488
(601) 351-5980
Mailing address
110 VILLA WAY, CLINTON, MS 39056-6106
(601) 720-7166
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
25671
TN
207Q00000X
Family Medicine Physician
904177
MS
363LF0000X
Family Nurse Practitioner
Primary
904177
MS
Other
Enumeration date
05/07/2019
Last updated
12/29/2023
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