Provider Demographics
NPI:1659984771
Name:PENNINGTON, AMY T (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-5426
Mailing Address - Country:US
Mailing Address - Phone:940-228-0612
Mailing Address - Fax:940-864-2779
Practice Address - Street 1:1400 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5426
Practice Address - Country:US
Practice Address - Phone:940-228-0612
Practice Address - Fax:940-864-2779
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily