Individual
MR. KEITH EDWIN PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
207 OLD LEXINGTON RD, THOMASVILLE, NC 27360-3428
(336) 476-2586
Mailing address
207 OLD LEXINGTON RD, THOMASVILLE, NC 27360-3428
(336) 476-2586
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
051810
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4630058715
RR MEDICARE
NC
05
—
8051375
—
NC
Enumeration date
06/27/2006
Last updated
10/27/2020
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