Provider Demographics
NPI:1639985617
Name:PENNY, KRYSTIN R (CHW)
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:R
Last Name:PENNY
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5271
Mailing Address - Country:US
Mailing Address - Phone:269-364-3905
Mailing Address - Fax:
Practice Address - Street 1:353 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3844
Practice Address - Country:US
Practice Address - Phone:269-345-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker