Provider Demographics
NPI:1295536381
Name:PENNOCK, ALYSSA DAWNE (BSN, RN, FNE)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWNE
Last Name:PENNOCK
Suffix:
Gender:
Credentials:BSN, RN, FNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 FELIX ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-3348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2809 FELIX ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-3348
Practice Address - Country:US
Practice Address - Phone:417-342-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007962364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal