NPIMap

Organization Active NPI

Kerry Pennington, PA

  • Family Medicine Physician
  • Warren, AR
National Provider Identifier
1447226253
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C5438 Issued in AR
Legal business name
KERRY PENNINGTON, PA
Practice address
1012 E Church St
Sutie a
Warren, AR 71671-3509
Phone
(870) 226-6754
Fax
(870) 226-7925
NPI assigned
Feb 23, 2006
Last updated
May 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

Name
Dr. Kerry F Pennington, M.D.NPI 1013983873
Title
President
Phone
(870) 226-6754

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C5438 AR Primary

Addresses

Primary practice location

1012 E Church St
Sutie a
Warren, AR 71671-3509

Mailing address

1012 E Church St
Sutie a
Warren, AR 71671-3509
Phone (870) 226-6754

Other identifiers 3

IdentifierTypeStateIssuer
133563762MedicaidAR
110722002MedicaidAR
5B909OtherARBCBS PROVIDER #

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1447226253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 E CHURCH ST",
            "address_2": "SUTIE A",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716713509",
            "telephone_number": "870-226-6754",
            "fax_number": "870-226-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 E CHURCH ST",
            "address_2": "SUTIE A",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716713509",
            "telephone_number": "870-226-6754",
            "fax_number": "870-226-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY PENNINGTON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-23",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "870-226-6754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "C5438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133563762",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110722002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "5B909",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.