Provider Demographics
NPI:1467490276
Name:STREBY, PENNY R (PA-C)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:R
Last Name:STREBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINECREST CT # 500
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-8031
Mailing Address - Country:US
Mailing Address - Phone:864-725-7900
Mailing Address - Fax:864-725-7910
Practice Address - Street 1:105 VINECREST CT # 500
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-725-7900
Practice Address - Fax:864-725-7910
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01941363A00000X
PAMA051606363A00000X
SC2068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03331211Medicaid
SC1905PAMedicaid
PA074237Medicare PIN
SCSC4014Medicare PIN
SC1905PAMedicaid