Provider Demographics
NPI:1225149685
Name:PENNINGTON, MELISSA P (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:P
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2900 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3900
Mailing Address - Country:US
Mailing Address - Phone:314-543-5294
Mailing Address - Fax:314-892-1658
Practice Address - Street 1:2900 LEMAY FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-543-5294
Practice Address - Fax:314-892-1658
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAWA PA 10004933363A00000X
MO2012037436363A00000X
MN11042363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant