Provider Demographics
NPI:1114188281
Name:PENNINGTON, JULIA ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ELIZABETH
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELIZABETH
Other - Last Name:RUNYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6813 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7007
Mailing Address - Country:US
Mailing Address - Phone:502-243-2622
Mailing Address - Fax:502-243-2692
Practice Address - Street 1:6813 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7007
Practice Address - Country:US
Practice Address - Phone:502-243-2622
Practice Address - Fax:502-243-2692
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5977P363LP0808X
KY3005977363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
636310OtherVALUEOPTIONS
000000613676OtherANTHEM PIN
KY3005977OtherAPRN LICENSE
636310OtherVALUEOPTIONS