Individual
PENNY FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2910 TRICOM ST STE 100, NORTH CHARLESTON, SC 29406-9351
(843) 572-9211
(843) 572-0457
Mailing address
PO BOX 751874, CHARLOTTE, NC 28275-1874
(843) 402-5200
(843) 402-5296
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
22420
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP6107
—
SC
Enumeration date
06/10/2019
Last updated
10/01/2025
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