| Doctor Name: | KIERAN L PENNING |
| NPI Number: | 1629166855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 71001464A |
| Business Practice Address: | 9660 Wicker Avenue 2nd Floor St John, IN - 463739487 |
| Business Phone Number: | 2192262380 |
| Business Fax Number: | 2192262381 |
| Mailing Address: | 9660 Wicker Avenue, 2nd Floor ST JOHN |
| State: | IN |
| Postal Code: | 463739487 |
| Phone Number: | 2192262380 |
| Fax Number: | 2192262381 |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 06/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71001464A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |