Provider Demographics
NPI:1427719582
Name:PENLEY, KRISTINE LYN (NP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LYN
Last Name:PENLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYN
Other - Last Name:HAGANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1201
Mailing Address - Country:US
Mailing Address - Phone:760-401-3556
Mailing Address - Fax:
Practice Address - Street 1:504 MCCURDY AVE S # 6
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5254
Practice Address - Country:US
Practice Address - Phone:256-638-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173740363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care