Jennifer Johanna Penne, APN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

A003632 Issued in AR

Practice address

2566 E Joyce Blvd
Fayetteville, AR 72703-4553

Phone

(479) 935-1000

Fax

(479) 935-2000

NPI assigned

May 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Missouri, Columbia School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Reding and Leach MD PLLCGroup PAC ID 7012258627, 62 clinicians

Texarkana Behavioral Associates LCGroup PAC ID 9436062379, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jennifer.penne.1@21565.direct.athenahealth.com

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.

• Reding & Leach MD PLLC

  • Psychiatry Physician
  • Little Rock, AR
  • NPI 1245723584
  Medicare reassignment Care Compare group NPD
• Texarkana Behavioral Associates, L.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Barling, AR
  • NPI 1467483677
  Medicare reassignment Care Compare group NPD
• Texarkana Behavioral Associates, L.C.

  • Psychiatric Hospital
  • Fayetteville, AR
  • NPI 1639137565
  NPD
• Eustasis Foundation, Inc

  • Voluntary or Charitable Agency
  • Springfield, MO
  • NPI 1386257780
  NPD

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1497968101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2566 E JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034553",
            "telephone_number": "479-935-1000",
            "fax_number": "479-935-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 E JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034553",
            "telephone_number": "479-935-1000",
            "fax_number": "479-935-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 N Mill Ave",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727014273",
            "country_code": "US",
            "telephone_number": "479-713-8350",
            "fax_number": "479-713-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNE",
        "first_name": "JENNIFER",
        "middle_name": "JOHANNA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R 72401",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "2021008266",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "A003632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193306758",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420094195",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittney Pember, PMHNP
• Margaret-Maria Pemu, LPC
• Durinda Pena, A.P.N.
• Aja R Pence
• Adreanna Megan Pendergraft
• Christina R Pennington
• Ivelisse Pennington, MHPP
• Matthew Walter Penquite
• Hannah Penzo, APRN
• Angela Theresa Perea, PSY.D.

• Psychiatric/Mental Health Nurse Practitioner in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.