Provider Demographics
NPI:1659576882
Name:PENNA, KELLY A (BA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:PENNA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NH
Mailing Address - Zip Code:03465-2400
Mailing Address - Country:US
Mailing Address - Phone:603-242-3614
Mailing Address - Fax:
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3748
Practice Address - Country:US
Practice Address - Phone:603-357-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator