Provider Demographics
NPI:1356895155
Name:PENTICO, KATHRYN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PENTICO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:PRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:3786 CENTRAL PIKE STE 130
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3498
Mailing Address - Country:US
Mailing Address - Phone:615-883-2200
Mailing Address - Fax:615-883-1104
Practice Address - Street 1:3786 CENTRAL PIKE STE 130
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3498
Practice Address - Country:US
Practice Address - Phone:615-883-2200
Practice Address - Fax:615-883-1104
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210852163W00000X
TN21521363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023490Medicaid