| Doctor Name: | PENNY D. VANCE |
| NPI Number: | 1588690689 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | R652334 |
| Business Practice Address: | 104 W Railroad Ave S Crystal Springs, MS - 390592111 |
| Business Phone Number: | 6018923063 |
| Business Fax Number: | 6018923570 |
| Mailing Address: | 2500 N State St, JACKSON |
| State: | MS |
| Postal Code: | 392164500 |
| Phone Number: | 6018923063 |
| Fax Number: | 6018923570 |
| NPI Enumeration Date: | 06/23/2006 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R652334 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |