Healthcare Provider Details

I. General information

NPI: 1285576371
Provider Name (Legal Business Name): LEIGHTON PENNINGTON T PENNINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 160
PENDLETON OR
97801-0160
US

IV. Provider business mailing address

PO BOX 160
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-240-8742
  • Fax: 541-240-8742
Mailing address:
  • Phone: 541-240-8742
  • Fax: 541-240-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number109232
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: