Provider Demographics
NPI:1275960304
Name:PENNYPACKER, REGGIE DARNELL (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:REGGIE
Middle Name:DARNELL
Last Name:PENNYPACKER
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1307 JACKIE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1566
Mailing Address - Country:US
Mailing Address - Phone:580-786-4018
Mailing Address - Fax:580-786-4021
Practice Address - Street 1:1307 JACKIE RD
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1566
Practice Address - Country:US
Practice Address - Phone:580-786-4018
Practice Address - Fax:580-786-4021
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76980363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care