Provider Demographics
NPI:1285137455
Name:PENIX, HERBERT LEE (CNP)
Entity type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:LEE
Last Name:PENIX
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HIGHLAND AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1993
Mailing Address - Country:US
Mailing Address - Phone:740-333-4950
Mailing Address - Fax:
Practice Address - Street 1:308 HIGHLAND AVE UNIT C
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1993
Practice Address - Country:US
Practice Address - Phone:740-333-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271826Medicaid