Healthcare Provider Details

I. General information

NPI: 1881821940
Provider Name (Legal Business Name): PENNY R WOOD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 CYPRESS RD
BENTON KY
42025-7116
US

IV. Provider business mailing address

961 CYPRESS RD
BENTON KY
42025-7116
US

V. Phone/Fax

Practice location:
  • Phone: 270-703-0517
  • Fax:
Mailing address:
  • Phone: 270-703-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005979
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: