Individual
KERRYANN MELISSA PENNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
16318 JAMAICA AVE, JAMAICA, NY 11432-4919
(347) 307-5857
Mailing address
16318 JAMAICA AVE, JAMAICA, NY 11432-4919
(347) 307-5857
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
646650
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404360
NY
Other
Enumeration date
10/04/2011
Last updated
08/15/2022
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