Laura Kettle Penkava, CRNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

1-126161 Issued in AL

Practice address

7191 Cahaba Valley Rd
Suite 300
Birmingham, AL 35242-6402

Phone

(205) 995-9909

Fax

(205) 930-2063

NPI assigned

Apr 4, 2013

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Certified Registered Nurse

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.

• Birmingham Internal Medicine Associates, LLC

  • Internal Medicine Physician
  • Birmingham, AL
  • NPI 1598796542

  Primary Care

  Medicare reassignment NPD
• Neurology and Neurodiagnostics of Alabama, LLC

  • Specialist
  • Hoover, AL
  • NPI 1750577706
  NPD (past)

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1962745315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 GRAN AVE",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35209",
            "telephone_number": "256-694-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7191 CAHABA VALLEY RD",
            "address_2": "SUITE 300",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352426402",
            "telephone_number": "205-995-9909",
            "fax_number": "205-930-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENKAVA",
        "first_name": "LAURA",
        "middle_name": "KETTLE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-04",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AL",
            "license": "1-126161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNP",
            "identifier": "1-126161",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fabio Pencle, MD
• Anquenetta Michelle Pendleton Khan
• Tatiana Renee Pendleton, OTR
• Piotr Penherski
• John Penick
• Alisha Leandra Penn, MS, LPC
• Kiara Penn, MSOT, OTR/L
• Nakasha Penn
• Tammy Penn
• Brandon Pennington, DMD

• Primary Care Nurse Practitioner in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Primary Care Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; 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.