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General NPI Number Information
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NPI Number | 1942318589
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Entity Type | Individual
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Provider Name | AMANDA S PENNY M.D
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 1867 CRANE RIDGE DR SUITE 101B
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City | JACKSON
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State | MS
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Zip | 39216-4910
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Country | US
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Telephone | 601-362-8776
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Fax |
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Provider Business Mailing Address
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Address Line | 1867 CRANE RIDGE DR SUITE 101B
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City | JACKSON
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State | MS
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Zip | 39216-4910
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A92773
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20303
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License Number State | MS
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