Provider Demographics
NPI:1629486923
Name:MATTHEWS, PENNY MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 MAXWELL CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37180-8588
Mailing Address - Country:US
Mailing Address - Phone:931-224-2973
Mailing Address - Fax:
Practice Address - Street 1:883 UNION ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-685-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN18979363L00000X
TN18979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner