Provider Demographics
NPI:1497468102
Name:PENNINGTON, MEEKA KAY
Entity Type:Individual
Prefix:MISS
First Name:MEEKA
Middle Name:KAY
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5007
Mailing Address - Country:US
Mailing Address - Phone:618-351-1031
Mailing Address - Fax:618-351-1107
Practice Address - Street 1:1130 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5007
Practice Address - Country:US
Practice Address - Phone:618-351-1031
Practice Address - Fax:618-351-1107
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information