Provider Demographics
NPI:1669101176
Name:MAGGARD, PENNIE CANDANCE
Entity type:Individual
Prefix:MS
First Name:PENNIE
Middle Name:CANDANCE
Last Name:MAGGARD
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 1:220 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:TX
Mailing Address - Zip Code:75930-2109
Mailing Address - Country:US
Mailing Address - Phone:409-586-4059
Mailing Address - Fax:
Practice Address - Street 1:220 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:TX
Practice Address - Zip Code:75930-2109
Practice Address - Country:US
Practice Address - Phone:409-586-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health