Provider Demographics
NPI:1265677686
Name:CANNADY, PENNI CAROL (ANP)
Entity Type:Individual
Prefix:MRS
First Name:PENNI
Middle Name:CAROL
Last Name:CANNADY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3110
Mailing Address - Country:US
Mailing Address - Phone:731-334-5312
Mailing Address - Fax:731-334-5311
Practice Address - Street 1:350 E PARKVIEW ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-334-5312
Practice Address - Fax:731-334-5311
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13828207RC0001X
TN0000013828363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002946Medicaid