Provider Demographics
NPI:1457586414
Name:PENNINGTON, DELILAH (FNP)
Entity Type:Individual
Prefix:
First Name:DELILAH
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CROCKER
Mailing Address - State:MO
Mailing Address - Zip Code:65452-9203
Mailing Address - Country:US
Mailing Address - Phone:573-736-2217
Mailing Address - Fax:573-736-5370
Practice Address - Street 1:101 12TH ST
Practice Address - Street 2:
Practice Address - City:CROCKER
Practice Address - State:MO
Practice Address - Zip Code:65452-9203
Practice Address - Country:US
Practice Address - Phone:573-736-2217
Practice Address - Fax:573-736-5370
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO060745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily