Provider Demographics
NPI:1568636785
Name:BUMPUS, PENELOPE JOY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:JOY
Last Name:BUMPUS
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 1:2525 21ST AVENUE SOUTH
Mailing Address - Street 2:NASHVILLE SKIN AND CANCER
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5601
Mailing Address - Country:US
Mailing Address - Phone:615-327-9797
Mailing Address - Fax:615-613-1329
Practice Address - Street 1:2525 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5601
Practice Address - Country:US
Practice Address - Phone:615-327-9797
Practice Address - Fax:615-613-0329
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000010889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily