Provider Demographics
NPI:1023885746
Name:PENNINGTON, JACQUELINE LAKALE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LAKALE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 EMERALD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2045
Mailing Address - Country:US
Mailing Address - Phone:314-761-3838
Mailing Address - Fax:314-868-8802
Practice Address - Street 1:2600 S LOOP W STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2812
Practice Address - Country:US
Practice Address - Phone:314-761-3838
Practice Address - Fax:314-868-8802
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider