Healthcare Provider Details

I. General information

NPI: 1528534955
Provider Name (Legal Business Name): BRANDI LE ANN PENNINGTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 UPPER GILCHRIST RD
MOUNT VERNON OH
43050-9084
US

IV. Provider business mailing address

41 FORD RD S
MANSFIELD OH
44905-2931
US

V. Phone/Fax

Practice location:
  • Phone: 740-399-8008
  • Fax: 740-399-8012
Mailing address:
  • Phone: 740-294-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023673
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.023673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: