Individual
THEA C PENNYWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7925 YOUREE DR, SUITE 220, SHREVEPORT, LA 71105-5127
(318) 424-3400
(318) 629-8712
Mailing address
7925 YOUREE DR, SUITE 220, SHREVEPORT, LA 71105-5127
(318) 424-3400
(318) 629-8712
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200405
LA
Other
Enumeration date
12/15/2010
Last updated
12/15/2010
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