Healthcare Provider Details

I. General information

NPI: 1194758987
Provider Name (Legal Business Name): PENNY A DUNNING- NEWELL APRN FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENNY A HARM

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
GRAVOIS MILLS MO
65037-6253
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax: 573-207-2773
Mailing address:
  • Phone: 877-406-2662
  • Fax: 573-207-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number089531
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: