Provider Demographics
NPI:1962918128
Name:VANOVER PENNIX, ANNETTE JOY (BA,SRNA,KMA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JOY
Last Name:VANOVER PENNIX
Suffix:
Gender:F
Credentials:BA,SRNA,KMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E SHOWALTER DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2036
Mailing Address - Country:US
Mailing Address - Phone:502-370-6888
Mailing Address - Fax:
Practice Address - Street 1:2250 THUNDERSTICK DR STE 1104
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-9009
Practice Address - Country:US
Practice Address - Phone:859-254-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator