Provider Demographics
NPI:1861632622
Name:POSITIVE CONNECTIONS, PLLC
Entity Type:Organization
Organization Name:POSITIVE CONNECTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-243-2622
Mailing Address - Street 1:6813 W HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7007
Mailing Address - Country:US
Mailing Address - Phone:502-243-2622
Mailing Address - Fax:502-243-2692
Practice Address - Street 1:6813 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7007
Practice Address - Country:US
Practice Address - Phone:502-243-2622
Practice Address - Fax:502-243-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
KY3004525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000609052OtherANTHEM PIN
D081722OtherVALUEOPTIONS
00986Medicare PIN