Provider Demographics
NPI:1962754820
Name:PENEBACKER, BRANDON POMAIKAI (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:POMAIKAI
Last Name:PENEBACKER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:504 MURRAY FORK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0958
Mailing Address - Country:US
Mailing Address - Phone:910-973-2530
Mailing Address - Fax:
Practice Address - Street 1:TAGAYTA DR BLDG C-1722
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant