MIKKA MICHELE PENDERGRASS AGACNP NPI 1649846304

NPI Information

  • NPI: 1649846304
  • Provider Name: MIKKA MICHELE PENDERGRASS, AGACNP
  • Classification: Nurse Practitioner - 363LA2100X
  • Specialization: Acute Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1950 CIRCLE OF HOPE DR
    SALT LAKE CITY, UT
    ZIP 84112
  • Phone: (801) 581-2436

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NPI Details

Mikka Michele Pendergrass, AGACNP is an acute care nurse practitioner in Salt Lake City, UT with 5 years of experience. Mikka Michele Pendergrass, AGACNP NPI is 1649846304. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1950 CIRCLE OF HOPE DR
SALT LAKE CITY, UT
ZIP 84112-500
Phone: (801) 581-2436

The NPI 1649846304 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 6/2/2021 and was last updated on 11/11/2021.

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
1363LA2100XNurse PractitionerAcute Care86680593102UTAHYes

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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