1326030685 NPI number — KIMBERLY M PENNING MD

Table of content: KIMBERLY M PENNING MD (NPI 1326030685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326030685 NPI number — KIMBERLY M PENNING MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENNING
Provider First Name:
KIMBERLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCKAY & RINGER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326030685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931634
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64193-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-461-8288
Provider Business Mailing Address Fax Number:
816-461-6586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 WORNALL RD
Provider Second Line Business Practice Location Address:
SUITE 336
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-5941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-6100
Provider Business Practice Location Address Fax Number:
816-461-6586
Provider Enumeration Date:
08/22/2005

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: 207V00000X , with the licence number:  100119 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 203615620 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100184860B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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