Makayla Marie Penner, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

U9054 Issued in TX

Practice address

6421 McCart Ave
Fort Worth, TX 76133-4702

Phone

(817) 263-7500

Fax

(817) 423-4140

NPI assigned

Mar 23, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpenner137249@cookchildrens.direct-ci.com
• Direct secure messaging: mpenner336090@direct.sw.org

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.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment NPD
• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD
• Cook Children'S Medical Center

  • Clinical Child & Adolescent Psychologist
  • Fort Worth, TX
  • NPI 1942509963
  NPD (past)

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1780260372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-6483",
            "fax_number": "682-885-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6421 MCCART AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761334702",
            "telephone_number": "817-263-7500",
            "fax_number": "817-423-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNER",
        "first_name": "MAKAYLA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "U9054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpenner137249@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "6421 McCart Ave",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761334702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John T Pender Jr., MD
• Marisa Pendery
• Monica Peng, MD
• Penguin Medical Supplies, Inc
• Penn Interventional Pain Center, LLC
• Michael William Penney, MD
• Taylor Penning
• Emily M Penninger, PNP
• Mark Penninger, FNP
• Lacie Pennington, DPT

• Pediatrics Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.