Basic Information
| Provider Information | |||||||||
| NPI: | 1275096158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENNINGTON | ||||||||
| FirstName: | RICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | 7048672308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 COURT DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048672141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2019 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 023671 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 001011689 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.