Provider Demographics
NPI:1588799829
Name:PENNINGTON, DENNIS R
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 HWY 277
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:AR
Mailing Address - Zip Code:71674
Mailing Address - Country:US
Mailing Address - Phone:870-222-5534
Mailing Address - Fax:
Practice Address - Street 1:2410 HWY 65 N
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654
Practice Address - Country:US
Practice Address - Phone:870-222-5534
Practice Address - Fax:870-222-6741
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator