IndividualActive
Glen Pettenger, PA-C
NPI 1801910609 · Medical Physician Assistant · Centerville, TX
Provider details
- NPI number
- 1801910609
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- PA00952 (TX)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
102 West Main Street
Centerville, TX 75833
Phone: (903) 536-2313
Fax: (903) 536-2207
Approximate (ZIP-level) locationGet directions
Mailing address
8148 Fm 1511
Oakwood, TX 75855-4067
Registry dates
- Enumerated
- 2007-03-19
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.