MR. ALEXANDER LEE PENDERGRASS


Address: 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061
Phone: 8179662960

MR. ALEXANDER LEE PENDERGRASS (NPI# 1982212841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1982212841
Entity Type Individual
Full Name MR. ALEXANDER LEE PENDERGRASS
Credential FNP-C
Practice Address 808 Woodrow Wilson Ray Cir
Bridgeport
TX 76426-2061
Mailing Address 3250 River Lodge Trl S Apt 420
Fort Worth
TX 76116-0830
Practice Telephone 8179662960
Mailing Telephone 8179662960
Enumeration Date 2020-07-16
Last Update Date 2020-07-16
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LF0000X Nurse Practitioner
Specialization: Family
1003207 TX Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 808 WOODROW WILSON RAY CIR
City BRIDGEPORT
State TX
Zip Code 76426-2061

Providers in the same location

NPI Name Taxonomy Address Enumeration
1720062698 David A. Ray Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2005-12-02
1144731464 Heart Health Clinic Pllc Internal Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2017-10-13
1225449119 Denise M. Casper, D.o., P.a. Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2014-05-13
1083748800 David A Ray Do Pa Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2007-03-15
1649304486 Jon W Copeland Do Pa Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2007-03-15
1417081142 David A Ray D O P A Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2007-03-15
1659324739 Michael A Millis Physician Assistant 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2006-05-18
1265484968 Jon Wayne Copeland Family Medicine 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2006-05-17
1871544486 Russell J Tanner Physician Assistant 808 Woodrow Wilson Ray Cir, Bridgeport, TX 76426-2061 2006-05-16

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1790169613 Victor Esmeraldo Dentist 1808 Chico Hwy, Bridgeport, TX 76426 2015-07-10
1376941013 K&h Dental Pa Clinic/Center 1808 Chico Highway, Bridgeport, TX 76426 2014-12-11
1710252572 Jonathon Stanley Scarborough Nurse Anesthetist, Certified Registered 1509 Dr. Hospital Drive, Bridgeport, TX 76426 2012-03-13
1124153010 Christopher Aaron Hicks Physical Therapist 707 Woodrow Wilson Ray Cir, Bridgeport, TX 76426 2007-02-22
1578636411 34hha, Inc Home Health 401 Center Ct., Bridgeport, TX 76426 2006-11-16
1295777902 West 380 Nursing Center Assisted Living Facility 2108 15th St, Bridgeport, TX 76426 2006-06-10
1780810234 Scc Partners Inc Skilled Nursing Facility 2108 15th St, Bridgeport, TX 76426 2009-06-10
1477175628 Noemi Araceli Meza Non-emergency Medical Transport (VAN) 1006 Newby Ave, Bridgeport, TX 76426-2030 2020-05-11
1992013692 Bridgeport Isd Local Education Agency (LEA) 2107 15th St, Bridgeport, TX 76426-2052 2010-09-16
1952853194 City of Ennis Skilled Nursing Facility 2108 15th St, Bridgeport, TX 76426-2055 2016-11-03
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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
1861915019 Stephanie Jean Fluharty Nurse Practitioner 1511 Johnson Ave Ste 104, Bridgeport, WV 26330-1016 2017-07-19
1730601006 Katherine Smith Carter Nurse Practitioner 68 Woodland Ave, Bridgeport, CT 06605-3457 2017-07-08
1285186148 Helen Leahy Nurse Practitioner 439 Mill Hill Ave., Bridgeport, CT 06610 2016-10-26
1588119408 Lisa M Finoia Nurse Practitioner 2800 Main St Fl 3, Bridgeport, CT 06606-4201 2016-08-20
1437568003 Donte Jamal Newsom Nurse Practitioner 1370 Johnson Ave Ste 202, Bridgeport, WV 26330-1378 2014-08-08
1053675033 Joanna R Fernandez Nurse Practitioner 500 Palisade Ave, Bridgeport, CT 06610-3458 2012-06-25
1558678623 Dermatology Outreach, LLC Nurse Practitioner 111 State St., Bridgeport, WV 26330 2010-09-09
1659546109 Christine Margaret Berte Nurse Practitioner 790 Fairfield Ave, Bridgeport, CT 06604-3701 2008-04-25
1043383508 Susan Flanigan Bates Nurse Practitioner Mcmwtc Bldg 3005, Hc 83 Box 1, Bridgeport, CA 93517 2006-11-15
1629048418 Renee Biehl Nurse Practitioner 761 Lindley St, Bridgeport, CT 06606-5043 2006-01-24
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Competitor

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City BRIDGEPORT
Zip Code 76426

Improve Information

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Dataset Information

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.

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