ERNESTO ANTONIO PENA-TEJEDA NPI 1619758620

NPI Information

  • NPI: 1619758620
  • Provider Name: ERNESTO ANTONIO PENA-TEJEDA
  • Classification: Physician Assistant - 363AS0400X
  • Specialization: Surgical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1068 CRESTHAVEN RD STE 500
    MEMPHIS, TN
    ZIP 38119
  • Phone: (901) 866-8525

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NPI Details

Ernesto Antonio Pena-tejeda is a surgical physician assistant in Memphis, TN with 3 years of experience. Ernesto Antonio Pena-tejeda NPI is 1619758620. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduation Year:2023

The provider's business location address is:

1068 CRESTHAVEN RD STE 500
MEMPHIS, TN
ZIP 38119-846
Phone: (901) 866-8525

The NPI 1619758620 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/6/2023 and was last updated on 3/13/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant338914LOUISIANANo
2363A00000XPhysician Assistant5999TENNESSEENo
3363AS0400XPhysician AssistantSurgical5999TENNESSEEYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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