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General NPI Number Information
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NPI Number | 1134648918
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Entity Type | Individual
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Provider Name | HEATHER R PENNIMAN NP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 482 HAWTHORNE DR NE
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City | NORTON
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State | VA
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Zip | 24273-2970
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Country | US
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Telephone | 276-437-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | KINGSPORT
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State | TN
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Zip | 37662-0009
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Country | US
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Telephone | 423-857-2066
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001202291
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024175335
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 0024175335
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License Number State | VA
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