Provider Demographics
NPI:1811293863
Name:PENNINGTON, ALLISON SWAIM (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:SWAIM
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:SWAIM
Other - Last Name:GOSNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2155
Mailing Address - Country:US
Mailing Address - Phone:606-833-0144
Mailing Address - Fax:
Practice Address - Street 1:1180 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-833-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV85698363LF0000X
KY3006922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK086080Medicare PIN