Provider Demographics
NPI:1205641065
Name:PENNINGTON, TIFFANY (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 E HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE LOTAWANA
Mailing Address - State:MO
Mailing Address - Zip Code:64086-7810
Mailing Address - Country:US
Mailing Address - Phone:816-877-1470
Mailing Address - Fax:
Practice Address - Street 1:28000 E HOWARD DR
Practice Address - Street 2:
Practice Address - City:LAKE LOTAWANA
Practice Address - State:MO
Practice Address - Zip Code:64086-7810
Practice Address - Country:US
Practice Address - Phone:816-877-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010042377164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse