Individual
DEVAN TYLER PENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATS
Contact information
Practice address
1 UNIVERSITY RD, PEMBROKE, NC 28372-8699
(910) 918-6990
Mailing address
1257 WHITEHALL RD, WHITEVILLE, NC 28472-5953
(910) 642-0453
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/29/2020
Last updated
03/29/2020
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