Provider Demographics
NPI:1508956392
Name:VELIE, PENNY LEIGH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LEIGH
Last Name:VELIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5118
Mailing Address - Country:US
Mailing Address - Phone:904-759-3255
Mailing Address - Fax:
Practice Address - Street 1:88 CLINIC RD
Practice Address - Street 2:
Practice Address - City:TATE
Practice Address - State:GA
Practice Address - Zip Code:30177-2588
Practice Address - Country:US
Practice Address - Phone:904-759-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC4232Medicare PIN
FLQ79461Medicare UPIN