Active NPI
Tiffany Pender
- Community Health Worker
- Imperial, MO
National Provider Identifier
1053028027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 15203
- Practice address
- 1117 Main St
Imperial, MO 63052-2323 - Phone
- (636) 464-1100
- NPI assigned
- Oct 31, 2022
- Last updated
- Oct 31, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | NU | ||
| Community Health Worker | 172V00000X | 15203 | MO | Primary |
Addresses
Primary practice location
1117 Main St
Imperial, MO 63052-2323
Mailing address
1117 Main St
Imperial, MO 63052-2323
Phone (636) 464-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15203 | MO | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1053028027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1117 MAIN ST",
"city": "IMPERIAL",
"state": "MO",
"postal_code": "630522323",
"telephone_number": "636-464-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1117 MAIN ST",
"city": "IMPERIAL",
"state": "MO",
"postal_code": "630522323",
"telephone_number": "636-464-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDER",
"first_name": "TIFFANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MO",
"license": "15203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Imperial, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.