Provider Demographics
NPI:1922756170
Name:PENNY, RACHEAL (RN, CCM)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2709
Mailing Address - Country:US
Mailing Address - Phone:859-322-8013
Mailing Address - Fax:
Practice Address - Street 1:32 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2709
Practice Address - Country:US
Practice Address - Phone:859-322-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1076524163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management