Provider Demographics
NPI:1992963334
Name:PENNISTON, CAREY SPEECE (DO)
Entity type:Individual
Prefix:DR
First Name:CAREY
Middle Name:SPEECE
Last Name:PENNISTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 LAPRADA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:214-321-2673
Mailing Address - Fax:214-321-4329
Practice Address - Street 1:10534 GARLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2637
Practice Address - Country:US
Practice Address - Phone:214-321-2673
Practice Address - Fax:214-321-4329
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine