Provider Demographics
NPI:1417529553
Name:PENNINGTON, CHRISTINE ELISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELISE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3015
Mailing Address - Country:US
Mailing Address - Phone:870-612-2209
Mailing Address - Fax:
Practice Address - Street 1:2794 S 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7020
Practice Address - Country:US
Practice Address - Phone:501-941-9242
Practice Address - Fax:501-441-2325
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21784331363LF0000X
AR216187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily