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General NPI Number Information
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NPI Number | 1487137931
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Entity Type | Individual
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Provider Name | REBEKAH PENNINGTON PA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 618 S MAIN ST
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City | REIDSVILLE
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State | NC
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Zip | 27320
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Country | US
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Telephone | 336-951-4501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 745040
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City | ATLANTA
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State | GA
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Zip | 30374-5040
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Country | US
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Telephone | 336-663-5220
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001011715
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License Number State | NC
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