Provider Demographics
NPI:1326420191
Name:PENTON, RACHEL POOLSON (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:POOLSON
Last Name:PENTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 KINGSTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-4995
Mailing Address - Country:US
Mailing Address - Phone:504-232-7557
Mailing Address - Fax:
Practice Address - Street 1:5413 TOBY LN
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2347
Practice Address - Country:US
Practice Address - Phone:504-232-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08345367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09430074Medicaid
LA2397770Medicaid
LA426661YH3UMedicare PIN