Active NPI
Donald Harris Pennington, MD
- Psychiatry Physician
- Clarksville, AR
National Provider Identifier
1093804197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C4630
- Practice address
- 1021 Poplar Street
Clarksville, AR 72830 - Phone
- (479) 754-8610
- Fax
- (479) 754-8788
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C4630 | AR | Primary |
Addresses
Primary practice location
1021 Poplar Street
Clarksville, AR 72830
Mailing address
350 Salem Road
Suite 1
Conway, AR 72034
Phone (501) 336-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 440060001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4630 | AR | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1093804197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 SALEM ROAD",
"address_2": "SUITE 1",
"city": "CONWAY",
"state": "AR",
"postal_code": "72034",
"telephone_number": "501-336-8300",
"fax_number": "501-329-3572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1021 POPLAR STREET",
"city": "CLARKSVILLE",
"state": "AR",
"postal_code": "72830",
"telephone_number": "479-754-8610",
"fax_number": "479-754-8788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "DONALD",
"middle_name": "HARRIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2011-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AR",
"license": "C4630",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "440060001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.