Healthcare Provider Details

I. General information

NPI: 1790512036
Provider Name (Legal Business Name): CAROLYN PENNINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 35
BRUNO WV
25611-0035
US

IV. Provider business mailing address

PO BOX 35
BRUNO WV
25611-0035
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-8587
  • Fax:
Mailing address:
  • Phone: 304-583-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: