MEDICARE: PENNI YOUNG GARLAND RNC, ARNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	R0076634	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245294016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNI YOUNG GARLAND RNC, ARNP

Provider Business Mailing Address
First Line	:	1101 S BELMONT AVE
Second Line	:	STE. 105
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6315
Country	:	US
Telephone Number	:	918-756-2533
Fax Number	:	918-756-9588

Provider Business Practice Location Address
First Line	:	1101 S BELMONT AVE
Second Line	:	STE. 105
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6315
Country	:	US
Telephone Number	:	918-756-2533
Fax Number	:	918-756-9588

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/01/2014

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