MEDICARE: DANIELLE PENNYWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	NA	LA

General Provider Information

NPI Number	:	1124972906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PENNYWELL

Provider Business Mailing Address
First Line	:	3007 KNIGHT ST STE 105
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2538
Country	:	US
Telephone Number	:	318-542-7728
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 KNIGHT ST STE 105
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2538
Country	:	US
Telephone Number	:	318-542-7728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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Directions to “ DANIELLE PENNYWELL ” Practice Location

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