Provider Demographics
NPI:1417095746
Name:PENNINGTON, TAMMY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:M
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:M
Other - Last Name:PENNINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4201 SPRINGHURST BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-425-6690
Mailing Address - Fax:502-425-6629
Practice Address - Street 1:501 E BROADWAY STE 340
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1799
Practice Address - Country:US
Practice Address - Phone:502-852-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR12552084P0800X
KY425032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry