Provider Demographics
NPI:1316565849
Name:STEVENS, PENNY KAY (RN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:KAY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EVANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4251
Mailing Address - Country:US
Mailing Address - Phone:337-463-4486
Mailing Address - Fax:337-462-2486
Practice Address - Street 1:216 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4251
Practice Address - Country:US
Practice Address - Phone:337-463-4486
Practice Address - Fax:337-462-2486
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN151947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse