Provider Demographics
NPI:1588491138
Name:PENNYMAN, TERIKA
Entity type:Individual
Prefix:
First Name:TERIKA
Middle Name:
Last Name:PENNYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 POTOMAC SQUARE WAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5810
Mailing Address - Country:US
Mailing Address - Phone:317-252-1265
Mailing Address - Fax:
Practice Address - Street 1:4950 POTOMAC SQUARE WAY UNIT 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5810
Practice Address - Country:US
Practice Address - Phone:317-252-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-017072-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care