Provider Demographics
NPI:1467190868
Name:PENNINGTON, LYDIA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
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 1:7715 E US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:KY
Mailing Address - Zip Code:41168-8807
Mailing Address - Country:US
Mailing Address - Phone:606-547-1303
Mailing Address - Fax:
Practice Address - Street 1:7715 E US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:KY
Practice Address - Zip Code:41168-8807
Practice Address - Country:US
Practice Address - Phone:606-547-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily