| Kerry Pennington, Pa | |
|
1012 E Church St Sutie A Warren AR 71671-3509 | |
| (870) 226-6754 | |
| (870) 226-7925 |
| Full Name | Kerry Pennington, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1012 E Church St, Warren, Arkansas |
| Authorized Official Name and Position | Kerry F Pennington (PRESIDENT) |
| Authorized Official Contact | 8702266754 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kerry Pennington, Pa 1012 E Church St Sutie A Warren AR 71671-3509 Ph: (870) 226-6754 | Kerry Pennington, Pa 1012 E Church St Sutie A Warren AR 71671-3509 Ph: (870) 226-6754 |
| NPI Number | 1447226253 |
|---|---|
| Provider Enumeration Date | 02/23/2006 |
| Last Update Date | 05/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447226253 | NPI | - | NPPES |
| 110722002 | Medicaid | AR | |
| 5B909 | Other | AR | BCBS PROVIDER # |
| 133563762 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C5438 (Arkansas) | Primary |
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