Individual provider · Type 1 NPI

Mallory Miller Pendergrass, AG-ACNP

Acute Care Nurse Practitioner · Jackson, TN

NPI number 1629475348 Active

Practice location

620 Skyline Dr
Jackson, TN 38301-3923

Specialties and licenses

TaxonomyCodeLicense
Acute Care Nurse Practitioner Primary 363LA2100X19221 (TN)

Acute Care Nurse Practitioner: Definition to come...

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About NPI 1629475348

Mallory Miller Pendergrass, AG-ACNP's National Provider Identifier is 1629475348, issued on Nov 24, 2014. The primary taxonomy on file is Acute Care Nurse Practitioner (363LA2100X), and the practice location is in Jackson, TN. The record was last updated on Jul 21, 2025.