Basic Information
Provider Information
NPI: 1558728014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PENNINGTON
FirstName: BEVERLY
MiddleName: GAIL
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 COMMERCE ST STE 700
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372011835
CountryCode: US
TelephoneNumber: 8327864970
FaxNumber: 8557375542
Practice Location
Address1: 2425 WEST LOOP S STE 200
Address2:  
City: HOUSTON
State: TX
PostalCode: 770274208
CountryCode: US
TelephoneNumber: 8327864970
FaxNumber: 8556111917
Other Information
ProviderEnumerationDate: 01/28/2016
LastUpdateDate: 11/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP129982TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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