Healthcare Provider Details

I. General information

NPI: 1629486923
Provider Name (Legal Business Name): PENNY MARIE MATTHEWS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 UNION ST
SHELBYVILLE TN
37160-2607
US

IV. Provider business mailing address

352 MAXWELL CHAPEL RD
UNIONVILLE TN
37180-8588
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-1145
  • Fax:
Mailing address:
  • Phone: 931-224-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN18979
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: