Provider Demographics
NPI:1790966109
Name:SNOWDEN, PENNY CAROL
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:CAROL
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:KY
Mailing Address - Zip Code:40385-9708
Mailing Address - Country:US
Mailing Address - Phone:859-369-5092
Mailing Address - Fax:859-369-5092
Practice Address - Street 1:591 COLLEGE HILL RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:KY
Practice Address - Zip Code:40385-9708
Practice Address - Country:US
Practice Address - Phone:859-369-5092
Practice Address - Fax:859-369-5092
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor