Provider Demographics
NPI:1104645761
Name:PENNINGTON, DAWN M (APRN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:PENNINGTON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5440
Mailing Address - Country:US
Mailing Address - Phone:502-536-7224
Mailing Address - Fax:888-419-6943
Practice Address - Street 1:9800 SHELBYVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5440
Practice Address - Country:US
Practice Address - Phone:502-536-7224
Practice Address - Fax:888-419-6943
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4015941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily