Provider Demographics
NPI:1720087828
Name:PENNINGTON, LYNN BERNAIRD (FNP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:BERNAIRD
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:BERNAIRD
Other - Last Name:LEUSZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5247 DIDESSE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9153
Mailing Address - Country:US
Mailing Address - Phone:225-765-3076
Mailing Address - Fax:225-765-3090
Practice Address - Street 1:5247 DIDESSE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9153
Practice Address - Country:US
Practice Address - Phone:225-765-3076
Practice Address - Fax:225-765-3090
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN030357 AP02978363LF0000X
LA030357363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1438855Medicaid
LAP00137724OtherRAILROAD MEDICARE
4B405DX80Medicare PIN
LAP00137724OtherRAILROAD MEDICARE
LA1438855Medicaid