NPIMap

Organization Active NPI

David Penner MD PLLC

  • Psychiatry Physician
  • Olympia, WA
National Provider Identifier
1407440001
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DAVID PENNER MD PLLC
Practice address
1801 W Bay Dr NW Ste 104
Olympia, WA 98502-4310
Phone
(360) 539-1736
Fax
(360) 350-5610
NPI assigned
Feb 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Eugene Penner, MDNPI 1114005584
Title
Dr
Phone
(360) 539-1736

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1801 W Bay Dr NW Ste 104
Olympia, WA 98502-4310

Mailing address

PO Box 23
Olympia, WA 98507-0023
Phone (360) 539-1736

Other practice location 1

8765 Tallon Ln NE Ste Q
Lacey, WA 98516-6654
Phone (360) 539-1736

Other practice location 2

609 Yelm Ave W Ste 4
Yelm, WA 98597-7474
Phone (360) 539-1736

Other identifiers 1

IdentifierTypeStateIssuer
2149000MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240807004769 WA Part B Supplier - Clinic/Group Practice 6507246956 Receives reassigned benefits from 2 practitioners
Practice locations: Lacey, WA; Olympia, WA

National Provider Directory

National Provider Directory

Locations

8765 Tallon Ln NE
Ste Q
Lacey, WA 98516
Phone (360) 539-1736

609 Yelm Ave W
Ste 4
Yelm, WA 98597
Phone (360) 539-1736

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1407440001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985070023",
            "telephone_number": "360-539-1736",
            "fax_number": "360-350-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W BAY DR NW STE 104",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985024310",
            "telephone_number": "360-539-1736",
            "fax_number": "360-350-5610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8765 Tallon Ln NE Ste Q",
            "address_purpose": "LOCATION",
            "city": "Lacey",
            "state": "WA",
            "postal_code": "985166654",
            "country_code": "US",
            "telephone_number": "360-539-1736",
            "fax_number": "360-350-5610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "609 Yelm Ave W Ste 4",
            "address_purpose": "LOCATION",
            "city": "Yelm",
            "state": "WA",
            "postal_code": "985977474",
            "country_code": "US",
            "telephone_number": "360-539-1736",
            "fax_number": "360-350-5610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DAVID PENNER MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-24",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "PENNER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "360-539-1736",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2149000",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.