Provider Demographics
NPI:1447090220
Name:PENNEY, KALIE AN (ATC)
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:AN
Last Name:PENNEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KALIE
Other - Middle Name:AN
Other - Last Name:WHITEHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:219 CANE CREEK LN APT 203
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-8952
Mailing Address - Country:US
Mailing Address - Phone:832-286-3482
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4710
Practice Address - Country:US
Practice Address - Phone:573-651-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230239062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer