MR. GLEN ROSS PETTENGER (NPI# 1801910609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801910609 |
| Entity Type | Individual |
| Full Name | MR. GLEN ROSS PETTENGER |
| Credential | PA-C |
| Practice Address |
102 West Main Street Centerville TX 75833 |
| Mailing Address |
8148 Fm 1511 Oakwood TX 75855-4067 |
| Practice Telephone | 9035362313 |
| Practice Fax Number | 9035362207 |
| Mailing Telephone | 9035362810 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00952 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
102 WEST MAIN STREET |
| City | CENTERVILLE |
| State | TX |
| Zip Code | 75833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881175313 | Texas Guardian Hcs, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2884 State Highway 75 S, Centerville, TX 75833 | 2018-08-23 |
| 1952897324 | Candace Arnell West | Registered Nurse | 6585 Fm 1511, Centerville, TX 75833 | 2018-07-09 |
| 1548621303 | Leon County | Voluntary or Charitable | 529 W Lassater, Centerville, TX 75833 | 2016-03-08 |
| 1255414744 | St. Joseph Regional Health Center | Clinic/Center | 102 West Main St., Centerville, TX 75833 | 2006-10-20 |
| 1861400798 | Homeland Lp | Durable Medical Equipment & Medical Supplies | 143 S Cass Street, Centerville, TX 75833 | 2006-08-04 |
| 1174591648 | Rtm Enterprises Inc | Ambulance | 309 West Main, Centerville, TX 75833 | 2006-03-10 |
| 1568519122 | Brazos Valley Community Action Agency, Inc. | Clinic/Center | 607 Lassater, Centerville, TX 75833 | 2007-01-05 |
| 1730295775 | Dennis James Ellison | Dentist | 912 N. Commerce St., Centerville, TX 75833-0129 | 2006-08-22 |
| 1235688755 | Justin Henne | Nurse Practitioner | 607 W Lassater, Centerville, TX 75833-1959 | 2016-09-26 |
| 1801251889 | Kelli Franklin | Counselor | 205 S Commerce St, Centerville, TX 75833-1965 | 2015-12-17 |
| Find all providers in zip 75833 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023618428 | Stephanie Ann Keener | Physician Assistant | 7774 Hythe Cir, Centerville, OH 45459-8705 | 2020-10-27 |
| 1245377746 | Paul Samuel Mccartney | Physician Assistant | 7073 Clyo Road, Centerville, OH 45459 | 2007-01-31 |
| 1285618017 | Jeffrey T Vercher | Physician Assistant | 8039 Washington Village Drive, Ste 100, Centerville, OH 45458 | 2005-12-05 |
| 1174652069 | Lauren Darlene Nevins | Physician Assistant | 6720 Loop Rd, Centerville, OH 45459-2161 | 2007-03-05 |
| 1225187776 | Kristi R Kaeff | Physician Assistant | 1975 Miamisburg Centerville Rd, Centerville, OH 45459-3811 | 2007-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831704576 | Leila Olive Adell | Physician Assistant | 1221 S Congress Ave Apt 331, Austin, TX 78704-2461 | 2020-09-10 |
| 1619591864 | Today Telemedicine Pllc | Physician Assistant | 404 Oxford St Apt 2219, Houston, TX 77007-2679 | 2020-06-03 |
| 1497384168 | Gregory C Etienne | Physician Assistant | 7400 N 4th St, Mcallen, TX 78504-1859 | 2020-04-05 |
| 1689202475 | Theodore Inthaphom | Physician Assistant | 25222 Northwest Fwy Apt 349, Cypress, TX 77429-1065 | 2020-03-29 |
| 1740816982 | Alyssa Conrad | Physician Assistant | 4818 Star Jasmine Dr, Austin, TX 78723-6059 | 2020-03-19 |
| 1114558335 | Erin Lynn Brown | Physician Assistant | 1504 Taub Loop Houston, Houston, TX 77030 | 2020-01-27 |
| 1245870930 | Jessica Grimaldo | Physician Assistant | 1200 Brooklyn Ave Ste 230, San Antonio, TX 78212-0010 | 2020-01-09 |
| 1730728528 | Holli Marie Beard | Physician Assistant | 2625 Scripture St Ste 101, Denton, TX 76201-2304 | 2019-12-27 |
| 1477191237 | Ronald Edwin Brown | Physician Assistant | 1427 Cypress Point Dr, Gunter, TX 75058-3201 | 2019-12-11 |
| 1053957910 | Rossalya Aracely Granda Gutierrez | Physician Assistant | 4150 N Collins St, Arlington, TX 76005-4547 | 2019-11-25 |
| Find all providers with the same taxonomy | ||||
| City | CENTERVILLE |
| Zip Code | 75833 |
Please comment or provide details below to improve the information on MR. GLEN ROSS PETTENGER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.