Doctor Name: | TIMOTHY R PENNISTON |
NPI Number: | 1144243692 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | 22047.305 |
Business Practice Address: | 2007 S Douglas Hwy Suite E2 Gillette, WY - 827185400 |
Business Phone Number: | 3076865750 |
Business Fax Number: | 3076865748 |
Mailing Address: | 2007 S Douglas Hwy, Suite E2 GILLETTE |
State: | WY |
Postal Code: | 827185400 |
Phone Number: | 3076865750 |
Fax Number: | 3076865748 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 22047.305 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |