Individual
PENNIE LEE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1 LINCOLN PKWY, SUITE 202, HATTIESBURG, MS 39402-3262
(601) 288-8050
(601) 288-8058
Mailing address
1 LINCOLN PKWY STE 202, HATTIESBURG, MS 39402-3261
(601) 288-8050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R865783
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R865783
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06733243
—
MS
01
—
12076121
CAQH ID #
MS
01
—
9429535
AETNA
MS
Enumeration date
01/11/2010
Last updated
05/27/2019
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