Healthcare Provider Details

I. General information

NPI: 1144183740
Provider Name (Legal Business Name): CAMERON PENNY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 BIENVILLE BLVD STE 102
OCEAN SPRINGS MS
39564-5736
US

IV. Provider business mailing address

13419 DURHAM LN
BILOXI MS
39532-1801
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-9620
  • Fax:
Mailing address:
  • Phone: 228-818-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-182215
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: