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General NPI Number Information
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NPI Number | 1295536381
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Entity Type | Individual
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Provider Name | ALYSSA DAWNE PENNOCK BSN, RN, FNE
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 2809 FELIX ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-3348
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Country | US
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Telephone | 417-342-6383
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 FELIX ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-3348
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Country | US
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Telephone |
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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 | 364SP1700X
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Taxonomy Name | Perinatal Clinical Nurse Specialist
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License Number | 2023007962
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License Number State | MO
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