Provider Demographics
NPI:1003861162
Name:PENNINGTON, JESSICA ABNEY (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ABNEY
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 BATTLEFIELD MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8332
Practice Address - Country:US
Practice Address - Phone:859-986-0302
Practice Address - Fax:859-986-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64055908Medicaid
KYK014642OtherMEDICARE
KY0767401Medicare ID - Type Unspecified