Doctor Name: | MRS. CARLA DONNELL PENTON |
NPI Number: | 1326370461 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R655538 |
Business Practice Address: | 2274 Highway 43 S Picayune, MS - 394668141 |
Business Phone Number: | 6017983989 |
Business Fax Number: | 6017983964 |
Mailing Address: | 2274 Highway 43 S, PICAYUNE |
State: | MS |
Postal Code: | 394668141 |
Phone Number: | 6017983989 |
Fax Number: | 6017983964 |
NPI Enumeration Date: | 01/30/2010 |
NPI Last Update Date: | 12/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R655538 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |