Provider Demographics
NPI:1083035356
Name:PENNY, AKILAH
Entity Type:Individual
Prefix:
First Name:AKILAH
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 NERO DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6913
Mailing Address - Country:US
Mailing Address - Phone:314-921-1109
Mailing Address - Fax:314-921-1266
Practice Address - Street 1:11875 NERO DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6913
Practice Address - Country:US
Practice Address - Phone:314-921-1109
Practice Address - Fax:314-921-1266
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant