Active NPI
Nina Drucilla Pennewell, PH.D.
- Clinical Psychologist
- Chattanooga, TN
National Provider Identifier
1144327628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P0000002028
- Practice address
- 6011 Shallowford Rd
Chattanooga, TN 37421 - Phone
- (800) 632-6074
- Fax
- (866) 341-7509
- NPI assigned
- Sep 19, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P0000002028 | TN | Primary |
Addresses
Primary practice location
6011 Shallowford Rd
Chattanooga, TN 37421
Mailing address
PO Box 10414
Largo, FL 33773
Phone (800) 632-6074
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3981285 | Medicaid | TN | |
| 4090448 | Other | TN | BCBS W PARADIGM |
| P00182194 | Other | TN | RR MEDICARE W PARADIGM |
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0000002028 | TN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wayne E. Tasker and Associates, Inc. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Morristown, TN
- NPI 1295974319
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188000000000",
"number": "1144327628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10414",
"city": "LARGO",
"state": "FL",
"postal_code": "33773",
"telephone_number": "800-632-6074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6011 SHALLOWFORD RD",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "37421",
"telephone_number": "800-632-6074",
"fax_number": "866-341-7509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNEWELL",
"first_name": "NINA",
"middle_name": "DRUCILLA",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-19",
"last_updated": "2007-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P0000002028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3981285",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS W PARADIGM",
"identifier": "4090448",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE W PARADIGM",
"identifier": "P00182194",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.