Provider Demographics
NPI:1659033207
Name:WAITE, PENELOPE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-9208
Mailing Address - Country:US
Mailing Address - Phone:606-401-6734
Mailing Address - Fax:
Practice Address - Street 1:200 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MC KEE
Practice Address - State:KY
Practice Address - Zip Code:40447-9208
Practice Address - Country:US
Practice Address - Phone:606-401-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1074415163W00000X
KY3016824363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse