Mallory Miller Pendergrass, AG-ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

19221 Issued in TN

Practice address

620 Skyline Dr
Jackson, TN 38301-3923

Phone

(731) 541-6900

NPI assigned

Nov 24, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Center Anesthesia Inc.

  • Anesthesiology Physician
  • Jackson, TN
  • NPI 1447591730
  Medicare reassignment NPD
• Jackson Anesthesiology Group, PLLC

  • Anesthesiology Physician
  • Jackson, TN
  • NPI 1770187734
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1629475348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "MALLORY",
        "middle_name": "MILLER",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-24",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "19221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Keith Pearson, D.D.S.
• Michael Brent Pearson, D.C.
• Nancy B Pechacek, FNP
• Linda Denise Peery, PA-C
• Josefina L Pena, PT
• Yi Peng
• Rebekah June Pennington
• Charles Lee Perkins II, M.D.
• Haley Perkins
• Sonia Estefania Pernia, PHARM.D.

• Acute Care Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Acute Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.