Healthcare Provider Details

I. General information

NPI: 1720982937
Provider Name (Legal Business Name): BETSY PENNINGTON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W MAIN ST
FLORENCE MS
39073-8106
US

IV. Provider business mailing address

137 W MAIN ST
FLORENCE MS
39073-8106
US

V. Phone/Fax

Practice location:
  • Phone: 601-954-3881
  • Fax:
Mailing address:
  • Phone: 601-954-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-2155
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: