Provider Demographics
NPI:1295341980
Name:WINSTEAD, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:WINSTEAD
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 1:1523 HIGHWAY 13 N
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-7480
Mailing Address - Country:US
Mailing Address - Phone:601-421-4300
Mailing Address - Fax:
Practice Address - Street 1:1523 HIGHWAY 13 N
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-7480
Practice Address - Country:US
Practice Address - Phone:601-421-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS801051049OtherDRIVERS LICENSE