Provider Demographics
NPI:1467639211
Name:FINCH, PENNY LANE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LANE
Last Name:FINCH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1100
Mailing Address - Country:US
Mailing Address - Phone:601-849-1682
Mailing Address - Fax:601-849-5179
Practice Address - Street 1:502 JACKSON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3300
Practice Address - Country:US
Practice Address - Phone:662-369-9525
Practice Address - Fax:662-304-4002
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR713562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09083707Medicaid
MS512I500468Medicare PIN