Individual
PENNY LYNN FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4000
Mailing address
4970 FM 2517, CARTHAGE, TX 75633-8481
(903) 754-1316
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP09138
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1R5310
MEDICARE
TX
05
—
425639801
—
TX
Enumeration date
01/17/2017
Last updated
09/01/2021
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