Provider Demographics
NPI:1972332484
Name:PENTON, KARLY (BSN, RNC-OB, IBCLC)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:PENTON
Suffix:
Gender:
Credentials:BSN, RNC-OB, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18099 VIA SERENA RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8731
Mailing Address - Country:US
Mailing Address - Phone:209-454-1140
Mailing Address - Fax:
Practice Address - Street 1:18099 VIA SERENA RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8731
Practice Address - Country:US
Practice Address - Phone:209-454-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-309124163WL0100X
374J00000X
CA95053475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse