Healthcare Provider Details

I. General information

NPI: 1578849618
Provider Name (Legal Business Name): ALESHA GAIL PENNINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR STE 400
LEXINGTON KY
40509-2124
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5220
  • Fax: 859-258-5405
Mailing address:
  • Phone: 859-258-6200
  • Fax: 859-425-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007201
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: