Provider Demographics
NPI:1013578954
Name:REGGIE PENNYPACKER, APRN-CNP, PLLC
Entity type:Organization
Organization Name:REGGIE PENNYPACKER, APRN-CNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:PENNYPACKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-656-6661
Mailing Address - Street 1:3125 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1362
Mailing Address - Country:US
Mailing Address - Phone:580-786-4018
Mailing Address - Fax:580-786-4018
Practice Address - Street 1:3125 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1362
Practice Address - Country:US
Practice Address - Phone:580-786-4018
Practice Address - Fax:580-786-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1275960304OtherNPI NUMBER