1497297493 NPI number — NATALINE EVELYN PENNINGTON CRNP

Table of content: NATALINE EVELYN PENNINGTON CRNP (NPI 1497297493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497297493 NPI number — NATALINE EVELYN PENNINGTON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNINGTON
Provider First Name:
NATALINE
Provider Middle Name:
EVELYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497297493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
STE 175
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-988-2014
Provider Business Mailing Address Fax Number:
615-208-1303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13150 HIGHWAY 43
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35653-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-331-2092
Provider Business Practice Location Address Fax Number:
256-331-2096
Provider Enumeration Date:
11/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1-097105 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com