Individual
PENNY D. VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
911 ELLIS AVE, JACKSON, MS 39209-6256
(601) 533-7016
Mailing address
PO BOX 746085, ATLANTA, GA 30374-6085
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
652334
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005238298
—
MS
01
—
P01629801
RAILROAD MEDICARE
MS
Enumeration date
06/23/2006
Last updated
03/10/2026
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