Provider Demographics
NPI:1790342335
Name:PENNY, ANDREA REED (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:REED
Last Name:PENNY
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 1:1022 N BRAGG BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3316
Mailing Address - Country:US
Mailing Address - Phone:910-495-7337
Mailing Address - Fax:910-495-0747
Practice Address - Street 1:5617 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1423
Practice Address - Country:US
Practice Address - Phone:910-423-7337
Practice Address - Fax:910-480-3029
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011850363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner