| Doctor Name: | MR. BRIAN TRAVIS PENDARVIS |
| NPI Number: | 1417952904 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ARNP |
| License Number: | R0067224 |
| Business Practice Address: | 205 South Main Street Noble, OK - 73068 |
| Business Phone Number: | 4058725403 |
| Business Fax Number: | 4058725407 |
| Mailing Address: | 205 South Main Street, Po Box 2096 NOBLE |
| State: | OK |
| Postal Code: | 73068 |
| Phone Number: | 4058725403 |
| Fax Number: | 4058725407 |
| NPI Enumeration Date: | 06/20/2005 |
| NPI Last Update Date: | 01/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R0067224 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |