Healthcare Provider Details

I. General information

NPI: 1376351189
Provider Name (Legal Business Name): PENNY ELIZABETH BUENING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E QUINCY ST
LEWISTOWN MO
63452-2560
US

IV. Provider business mailing address

PO BOX 273
CANTON MO
63435-0273
US

V. Phone/Fax

Practice location:
  • Phone: 573-215-2715
  • Fax: 573-497-2322
Mailing address:
  • Phone: 660-216-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025043789
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.031247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: