MEDICARE: ABBY L PENNINGTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA966	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255412292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY L PENNINGTON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 737100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-6374
Country	:	US
Telephone Number	:	317-706-7246
Fax Number	:	317-706-3417

Provider Business Practice Location Address
First Line	:	2416 REGENCY RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2954
Country	:	US
Telephone Number	:	859-278-1316
Fax Number	:	859-276-3847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	01/21/2026

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