DR. CONNIE JO PENNINGTON (NPI# 1790783330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790783330 |
| Entity Type | Individual |
| Full Name | DR. CONNIE JO PENNINGTON |
| Credential | M.D. |
| Practice Address |
2306 Knob Creek Rd Suite 100 Johnson City TN 37604-2366 |
| Practice Telephone | 4236101177 |
| Practice Fax Number | 4236101179 |
| Mailing Telephone | 4236101177 |
| Mailing Fax Number | 4236101179 |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2013-03-06 |
| NPI Deactivation Date | 03/15/2006 |
| NPI Reactivation Date | 2006-03-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MD0000030358 | TN | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3370584 | 05 | |
| TN | 3875906 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730737362 | Connie Pennington | Technician | 709 Cactus Bloom Ln, Las Vegas, NV 89107-1237 | 2019-08-27 |
| Street Address |
2306 KNOB CREEK RD SUITE 100 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-2366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497142137 | Knob Creek Oral Clinic | Clinic/Center | 2306 Knob Creek Rd, Suite 108, Johnson City, TN 37604-2366 | 2015-04-21 |
| 1801051750 | Truelight Eye Care, Pllc | Optometrist | 2306 Knob Creek Rd, #106, Johnson City, TN 37604-2366 | 2008-07-21 |
| 1477716835 | James Emerson Sheffey | Specialist | 2306 Knob Creek Rd, Suite 100, Johnson City, TN 37604-2366 | 2008-07-07 |
| 1497927115 | Southside Senior Care LLC | Optometrist | 2306 Knob Creek Rd, Johnson City, TN 37604-2366 | 2008-04-02 |
| 1972608974 | Samuel E Cox | Optometrist | 2306 Knob Creek Rd, Suite 106, Johnson City, TN 37604-2366 | 2006-09-14 |
| 1316930662 | Kathryn Allyson Bohlman | Optometrist | 2306 Knob Creek Rd, #106, Johnson City, TN 37604-2366 | 2005-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144620881 | Jennifer Spalik | Specialist | 167 N Hudson St, Johnson City, NY 13790-1414 | 2014-08-29 |
| 1417128968 | The Michal Child Development Center | Specialist | 302 Wesley St Ste 10, Johnson City, TN 37601-1769 | 2008-03-12 |
| 1922278480 | Mountainview Oral & Maxillofacial Surgery, P.C. | Specialist | 535 Columbia Dr, Johnson City, NY 13790-3302 | 2008-03-11 |
| 1346390937 | East Tennessee Anesthesia Services. LLC | Specialist | 221 Shadowood Dr, Johnson City, TN 37604-1128 | 2007-01-12 |
| 1962429647 | Tri-state Cardiology | Specialist | 2408 Susannah St, Ste.1, Johnson City, TN 37601-1728 | 2006-07-17 |
| 1366476657 | Gauri K Bhardwaj | Specialist | 699 Main St, Johnson City, NY 13790-1743 | 2006-07-10 |
| 1235168949 | Gamal S Boutros | Specialist | 329 Wesley Street, Suite 1, Johnson City, TN 37601-1721 | 2006-07-03 |
| 1740216910 | Daniel M O'roark | Specialist | 701 N State of Franklin Rd, Ste 9, Johnson City, TN 37604-3645 | 2006-06-22 |
| 1336135011 | Mohamad Isam Abdelazim | Specialist | 700 Harry L Dr, Johnson City, NY 13790-1145 | 2005-09-27 |
| 1922009521 | Elizabeth C. Smith | Specialist | 302 Wesley St, Suite 10, Johnson City, TN 37601-1740 | 2005-08-03 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.