Provider Demographics
NPI:1013983873
Name:PENNINGTON, KERRY FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:FRANKLIN
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1012 E CHURCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3509
Mailing Address - Country:US
Mailing Address - Phone:870-226-6754
Mailing Address - Fax:870-226-7925
Practice Address - Street 1:1012 E CHURCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3509
Practice Address - Country:US
Practice Address - Phone:870-226-6754
Practice Address - Fax:870-226-7925
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR432635OtherHEALTHLINK
AR101336001Medicaid
AR12791000000OtherQUALCHOICE PROVIDER #
AR710554390OtherUNITED HEALTHCARE
AR54011OtherBCBS PROVIDER #
AR5733222OtherAETNA
AR101336001Medicaid
AR010011939Medicare PIN
ARD84325Medicare UPIN