Provider Demographics
NPI:1578849618
Name:PENNINGTON, ALESHA GAIL (APRN)
Entity Type:Individual
Prefix:
First Name:ALESHA
Middle Name:GAIL
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-425-4004
Practice Address - Street 1:160 N EAGLE CREEK DR STE 400
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2124
Practice Address - Country:US
Practice Address - Phone:859-258-5220
Practice Address - Fax:859-258-5405
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007201363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100185490Medicaid