Provider Demographics
NPI:1649692922
Name:PENNINGTON, AMBER DIANE (FNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DIANE
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 1:44946 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-5630
Mailing Address - Country:US
Mailing Address - Phone:205-557-1300
Mailing Address - Fax:205-557-1300
Practice Address - Street 1:44946 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5630
Practice Address - Country:US
Practice Address - Phone:205-557-1300
Practice Address - Fax:205-557-1300
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-121998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily