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General NPI Number Information
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NPI Number | 1417529553
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Entity Type | Individual
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Provider Name | CHRISTINE ELISE PENNINGTON APRN
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Gender | Female
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 2794 S 2ND ST STE D
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City | CABOT
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State | AR
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Zip | 72023-7020
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Country | US
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Telephone | 501-941-9242
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Fax | 501-441-2325
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Provider Business Mailing Address
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Address Line | 1138 E MAIN ST
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City | BATESVILLE
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State | AR
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Zip | 72501-3015
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Country | US
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Telephone | 870-612-2209
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21784331
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License Number State | AR
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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 | 216187
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License Number State | AR
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