Healthcare Provider Details

I. General information

NPI: 1386348654
Provider Name (Legal Business Name): FERREN PANNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 PINEY FOREST RD
DANVILLE VA
24540-2860
US

IV. Provider business mailing address

112 WOODS CT
SOUTH BOSTON VA
24592-1100
US

V. Phone/Fax

Practice location:
  • Phone: 434-710-4210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024186830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: