Provider Demographics
NPI:1326342239
Name:VACHON, PENELOPE LYNN (DNP)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:LYNN
Last Name:VACHON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 SAVAGE RD STE 100E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4788
Mailing Address - Country:US
Mailing Address - Phone:843-793-1353
Mailing Address - Fax:843-818-4172
Practice Address - Street 1:1941 SAVAGE RD STE 100E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4788
Practice Address - Country:US
Practice Address - Phone:843-793-1353
Practice Address - Fax:843-818-4172
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4436363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1774Medicaid
SC9604OtherMEDICARE PTAN
SC9604OtherMEDICARE PTAN
SCAA64789223Medicare PIN