| Doctor Name: | ALICIA PENDERGRASS |
| NPI Number: | 1063883767 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 19686 |
| Business Practice Address: | 103 Sum Mor Dr West Columbia, SC - 291694828 |
| Business Phone Number: | 8032449212 |
| Business Fax Number: | |
| Mailing Address: | 116 Standard Warehouse Road, LUGOFF |
| State: | SC |
| Postal Code: | 290789670 |
| Phone Number: | 8034386023 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2015 |
| NPI Last Update Date: | 01/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 19686 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |