National Provider Identifier Database

KEVIN PENDLEBURY, CDE – NPI #1528209129
Diabetes Educator


Contact Information

KEVIN PENDLEBURY, CDE
MISSION RD
FORT HALL, ID83203-0306
Phone: 208-238-2400
Fax: 208-238-5462
Website:
Specialty Taxonomy Code
* Diabetes Educator 163WD0400X
Registered Nurse 163W00000X

* Indicates primary specialty

NPI Profile & details for KEVIN PENDLEBURY

NPI Number 1528209129
Credentials CDE
Entity Individual
Enumeration date 03/12/2009
Last updated 03/12/2009 - About 17 years ago
Sole proprietor1 No
Identifiers
  • ID License #: N31309
  • IL License #: 2061-0302
  • ID Medicaid: 003399100
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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