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Contact Information

KEVIN PENDLEBURY, CDE
MISSION RD
FORT HALL, ID83203-0306
 Phone: 208-238-2400
 Fax: 208-238-5462
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diabetes Educator

163WD0400X
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for KEVIN PENDLEBURY · (Male)

NPI Number 1528209129
Status Active
Credentials CDE
Entity Individual
Enumeration date 03/12/2009
Last updated 03/12/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • ID License # N31309
  • IL License # 2061-0302
  • ID Medicaid 003399100
Hospital affiliation(s) Not Available
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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