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General NPI Number Information
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NPI Number | 1265677686
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Entity Type | Individual
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Provider Name | PENNI CAROL CANNADY ANP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 350 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-334-5312
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Fax | 731-334-5311
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Provider Business Mailing Address
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Address Line | 350 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3110
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Country | US
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Telephone | 731-334-5312
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Fax | 731-334-5311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 13828
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0000013828
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License Number State | TN
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