Provider Demographics
NPI:1417024480
Name:PENNY, KATHERINE E (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:E
Last Name:PENNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:7205 W CENTER RD STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2387
Practice Address - Country:US
Practice Address - Phone:402-392-7684
Practice Address - Fax:531-355-0001
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0572560Medicaid
NE1201055Medicaid
NE1201309Medicaid
NE01264OtherBCBS OF NEBRASKA
NE1201496Medicaid
NE1201464Medicaid
NE1201500Medicaid
NE1201054Medicaid
IA1572560Medicaid
NE240594OtherMIDLANDS CHOICE
NE1201369Medicaid
IA3572560Medicaid