Michelle Pendergraph

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

4161 Sycamore Dairy Rd
Fayetteville, NC 28303-3460

Phone

(252) 341-4192

NPI assigned

Sep 23, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle Pendergraph-Rose Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1710538541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2632 DANIEL BOONE LN",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283488026",
            "telephone_number": "910-388-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 SYCAMORE DAIRY RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033460",
            "telephone_number": "252-341-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAPH",
        "first_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "PENDERGRAPH-ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maya Pelletier
• Kamari Pemberton
• Sharisse Desheal Pemberton
• Pembroke Drug Center
• Subbarao Venkata Pemmaraju, M.D.
• Satisha Pendergrast
• Linda Pendleton, P.H.D.
• Aimee Penebacker
• Hao Peng
• Robert Pennebaker, PMHNP-BC, LCSW

• Behavior Technician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Behavior Technician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.