Theresa Louise Pennington, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2016001340 Issued in MO

Practice address

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573

Phone

(573) 776-2600

NPI assigned

Jan 26, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

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.

• Poplar Bluff Hma Physician Management, LLC

  • Family Medicine Physician
  • Poplar Bluff, MO
  • NPI 1598710147
  Medicare reassignment NPD

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1720445463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14030 HIGHWAY 160",
            "city": "HARVIELL",
            "state": "MO",
            "postal_code": "639458161",
            "telephone_number": "573-714-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-776-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3098 Oak Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "639018938",
            "country_code": "US",
            "telephone_number": "573-778-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14030 Highway 160",
            "address_purpose": "LOCATION",
            "city": "Harviell",
            "state": "MO",
            "postal_code": "639458161",
            "country_code": "US",
            "telephone_number": "573-714-4228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "THERESA",
        "middle_name": "LOUISE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-26",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2016001340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhonda Lea Payne
• Peaceful Pines Residential Care, Inc.
• Michael R. Penney, OD
• Amy Michelle Pennington, NP
• Stefanie Sue Pennington, LPN
• Timothy Paul Pennington, LCSW
• Julia Leeann Perryman
• Tiffany Persons
• Richard Pestillos, PT
• Rebecca Peters

• Family Nurse Practitioner in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.