Provider Demographics
NPI:1538884978
Name:PENN, SARAH BETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:PENN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:ENYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:624 W LOCKLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2003
Mailing Address - Country:US
Mailing Address - Phone:660-268-4006
Mailing Address - Fax:660-258-9006
Practice Address - Street 1:245 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3031
Practice Address - Country:US
Practice Address - Phone:660-752-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022039568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily