| Doctor Name: | JEANNIE D PENCE |
| NPI Number: | 1063637106 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CANP |
| License Number: | R682519 |
| Business Practice Address: | 1542 Medical Park Cir Tupelo, MS - 388016560 |
| Business Phone Number: | 6628444711 |
| Business Fax Number: | 6628449619 |
| Mailing Address: | 1542 Medical Park Cir, TUPELO |
| State: | MS |
| Postal Code: | 388016560 |
| Phone Number: | 6628444711 |
| Fax Number: | 6628449619 |
| NPI Enumeration Date: | 04/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | R682519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |