Provider Demographics
NPI:1245294016
Name:GARLAND, PENNI YOUNG (RNC, ARNP)
Entity type:Individual
Prefix:
First Name:PENNI
Middle Name:YOUNG
Last Name:GARLAND
Suffix:
Gender:F
Credentials:RNC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S BELMONT AVE
Mailing Address - Street 2:STE. 105
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6315
Mailing Address - Country:US
Mailing Address - Phone:918-756-2533
Mailing Address - Fax:918-756-9588
Practice Address - Street 1:1101 S BELMONT AVE
Practice Address - Street 2:STE. 105
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6315
Practice Address - Country:US
Practice Address - Phone:918-756-2533
Practice Address - Fax:918-756-9588
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0076634363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200053850AMedicaid
OKOKAAA2103Medicare PIN