Kathleen Mary Prendergast, APN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ00108400 Issued in NJ

Practice address

60 S Fullerton Ave Ste 210
Montclair, NJ 07042-2663

Phone

(973) 744-6522

Fax

(973) 744-6362

NPI assigned

Jul 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2017 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669498846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 WASHBURN PL",
            "city": "CALDWELL",
            "state": "NJ",
            "postal_code": "070065917",
            "telephone_number": "973-228-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 S FULLERTON AVE STE 210",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422663",
            "telephone_number": "973-744-6522",
            "fax_number": "973-744-6362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "KATHLEEN",
        "middle_name": "MARY",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00108400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joella Pounds, ATC
• Richard L Pounds, LCSW
• Harriet M Power, LCSW
• Premier Healthcare Center, LLC
• Barbara Prempeh, PSYD
• Arthur Lee Pressley Jr., PHD
• Prestige-First Mountain Company LLC
• Prestige-First Mountain Company LLC
• Primary Care Partners, LLC (Montclair Pediatric Group)
• Francis P Prior, MD FACC

• Psychiatric/Mental Health Nurse Practitioner in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.