Robert Pennebaker, PMHNP-BC, LCSW

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

5005524 Issued in NC

Practice address

2931 Breezewood Ave Ste 104
Fayetteville, NC 28303-5281

Phone

(910) 491-1134

Fax

(910) 491-9781

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Robert C Pennebaker PLLCGroup PAC ID 3870802010, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Robert C. Pennebaker PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, NC
  • NPI 1144657677

  Clinical

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1609957505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2931 BREEZEWOOD AVE STE 104",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035281",
            "telephone_number": "910-491-1134",
            "fax_number": "910-491-9781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 BREEZEWOOD AVE STE 104",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035281",
            "telephone_number": "910-491-1134",
            "fax_number": "910-491-9781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNEBAKER",
        "first_name": "ROBERT",
        "credential": "PMHNP-BC, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C002032",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5005524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Pendergraph
• Satisha Pendergrast
• Linda Pendleton, P.H.D.
• Aimee Penebacker
• Hao Peng
• Sara Penney, LCMHC
• Charmaile Pennie, LCSWA
• Philip Sutherland Perdue III, DMD
• Aynara Sharlotte Perez-Sena
• Iraida Perez, MSW

• Psychiatric/Mental Health Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.