Healthcare Provider Details

I. General information

NPI: 1215966791
Provider Name (Legal Business Name): KATHY A PENNY ANP, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GENESEE ST BK BUILDING 1ST FLR
ROCHESTER NY
14611
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-3591
  • Fax: 585-368-3620
Mailing address:
  • Phone: 585-368-3691
  • Fax: 585-368-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: