Provider Demographics
NPI:1609531623
Name:PENNOCK, CIARA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CIARA
Middle Name:
Last Name:PENNOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E ALLEN ST STE A
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1184
Mailing Address - Country:US
Mailing Address - Phone:660-563-5555
Mailing Address - Fax:
Practice Address - Street 1:600 E ALLEN ST STE A
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336-1184
Practice Address - Country:US
Practice Address - Phone:660-563-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021043083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily