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MR. GLEN ROSS PETTENGER PA-C
NPI 1801910609
Physician Assistant - Medical in Centerville, TX

Active since March 19, 2007
102 WEST MAIN STREET, CENTERVILLE, TX 75833(903) 536-2313(903) 536-2207 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mr. Glen Ross Pettenger Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GLEN ROSS PETTENGER PA-C (NPI 1801910609) is an individual medical provider in Centerville, Texas, licensed in Texas (PA00952) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1801910609
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. GLEN ROSS PETTENGERCredential: PA-C
Location Address102 WEST MAIN STREETCenterville, TX 75833
Mailing Address8148 Fm 1511Oakwood, TX 75855-4067 · (903) 536-2810
Phone(903) 536-2313
Fax(903) 536-2207
Sole ProprietorNo
Enumeration DateMarch 19, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1801910609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in TX · PA00952
102 WEST MAIN STREET, Centerville, TX 75833
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glen Pettenger's NPI number?

The NPI number for Glen Pettenger is 1801910609. It was assigned to this individual provider in the NPPES registry on March 19, 2007.

Where is Glen Pettenger located?

Glen Pettenger practices at 102 West Main Street, Centerville, TX 75833. The listed phone number is (903) 536-2313.

What is Glen Pettenger's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Glen Pettenger was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.