Individual
MALLORY MILLER PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6900
Mailing address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-0249
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
19221
TN
Other
Enumeration date
11/24/2014
Last updated
07/21/2025
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