Provider Demographics
NPI:1255092672
Name:PENINGTON, DANIELLE M (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:PENINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29475 W 189TH TER
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9428
Mailing Address - Country:US
Mailing Address - Phone:913-856-5577
Mailing Address - Fax:913-856-3907
Practice Address - Street 1:29475 W 189TH TER
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9428
Practice Address - Country:US
Practice Address - Phone:913-856-5577
Practice Address - Fax:913-956-3907
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant