Provider Demographics
NPI:1881623957
Name:PENNINGTON, PATRICIA (FNPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3167
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-3167
Mailing Address - Country:US
Mailing Address - Phone:318-323-6405
Mailing Address - Fax:318-410-8290
Practice Address - Street 1:210 LAYTON AVE STE 20
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8548
Practice Address - Country:US
Practice Address - Phone:318-323-6405
Practice Address - Fax:318-410-8290
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN077208 AP03480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C408Medicare ID - Type Unspecified