National Provider Identifier Database

DESIREE B PENDERGRASS, MD – NPI #1255425989
Pediatrics

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.


Contact Information

DESIREE B PENDERGRASS, MD
2500 N STATE ST
JACKSON, MS39216-4500
Phone: 601-815-8982
Fax:
Website:
Specialty Taxonomy Code
* Pediatrics 208000000X
Public Health & General Preventive Medicine 2083P0901X

* Indicates primary specialty

NPI Profile & details for DESIREE B PENDERGRASS

NPI Number 1255425989
Credentials MD
Entity Individual
Enumeration date 10/03/2006
Last updated 02/17/2017 - About 9 years ago
Sole proprietor1 No
Identifiers
  • MS License #: 24712
  • TX License #: H4609
  • MS Medicaid: 05359595
  • TX Other: 8G6058 BC/BS
  • TX Other: 155349101 FIRSTCARE MEDICAID
  • TX Other: 8J1510 MEDICARE
  • TX Other: 08907561 NM MEDICAID
  • TX Other: 200101350A OK MEDICARE
  • TX Other: 132232307 TMHP
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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