Active NPI
Lindsey Alexander Pennington, MD
- Facial Plastic Surgery Physician
- Shreveport, LA
National Provider Identifier
1134411507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Facial Plastic Surgery Physician
- License
- MD.205826
- Practice address
- 1501 Kings Hwy
Otolaryngology
Shreveport, LA 71103-4228 - Phone
- (318) 813-2690
- Fax
- (318) 813-2692
- NPI assigned
- May 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Facial Plastic Surgery Physician | 207YS0123X | MD.205826 | LA | Primary |
Addresses
Primary practice location
1501 Kings Hwy
Otolaryngology
Shreveport, LA 71103-4228
Mailing address
1501 Kings Hwy
Otolaryngology
Shreveport, LA 71103-4228
Phone (318) 813-2690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2144464 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 6, 2022 through Oct 6, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1134411507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "OTOLARYNGOLOGY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-813-2690",
"fax_number": "318-813-2692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "OTOLARYNGOLOGY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-813-2690",
"fax_number": "318-813-2692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "LINDSEY",
"middle_name": "ALEXANDER",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-04",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "207YS0123X",
"taxonomy_group": "",
"desc": "Otolaryngology, Facial Plastic Surgery",
"state": "LA",
"license": "MD.205826",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2144464",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.