Individual
PENNEYE HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1208 OFFICE PARK DR, OXFORD, MS 38655-3597
(662) 234-9888
Mailing address
PO BOX 381468, GERMANTOWN, TN 38183-1468
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
649112
MS
367500000X
Certified Registered Nurse Anesthetist
APRN9364903
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
R649112
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000124255
—
MS
Enumeration date
01/18/2006
Last updated
02/16/2026
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