Provider Demographics
NPI:1649705708
Name:LEVILL, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:LEVILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 ROSCOE VEAZEY RD
Mailing Address - Street 2:
Mailing Address - City:MANITOU
Mailing Address - State:KY
Mailing Address - Zip Code:42436-9748
Mailing Address - Country:US
Mailing Address - Phone:270-875-5819
Mailing Address - Fax:
Practice Address - Street 1:465 ROSCOE VEAZEY RD
Practice Address - Street 2:
Practice Address - City:MANITOU
Practice Address - State:KY
Practice Address - Zip Code:42436-9748
Practice Address - Country:US
Practice Address - Phone:270-875-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011279OtherAPRN STATE LICENSE