Healthcare Provider Details

I. General information

NPI: 1497538862
Provider Name (Legal Business Name): LINDSAY PENNOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SOUTHWIND PL STE 201
MANHATTAN KS
66503-3159
US

IV. Provider business mailing address

217 SOUTHWIND PL STE 201
MANHATTAN KS
66503-3159
US

V. Phone/Fax

Practice location:
  • Phone: 989-600-9244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07180
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number140329
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: