| Reggie Pennypacker, Aprn-cnp, Pllc | |
|
1307 Jackie Rd Duncan OK 73533-1566 | |
| (580) 786-4018 | |
| (580) 786-4021 |
| Full Name | Reggie Pennypacker, Aprn-cnp, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1307 Jackie Rd, Duncan, Oklahoma |
| Authorized Official Name and Position | Reggie Darnell Pennypacker (NURSE PRACTITIONER) |
| Authorized Official Contact | 5806566661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reggie Pennypacker, Aprn-cnp, Pllc 1307 Jackie Rd Duncan OK 73533-1566 Ph: (580) 786-4018 | Reggie Pennypacker, Aprn-cnp, Pllc 1307 Jackie Rd Duncan OK 73533-1566 Ph: (580) 786-4018 |
| NPI Number | 1013578954 |
|---|---|
| Provider Enumeration Date | 06/21/2019 |
| Last Update Date | 06/21/2019 |
| Medicare PECOS PAC ID | 2668708371 |
|---|---|
| Medicare Enrollment ID | O20190801001353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013578954 | NPI | - | NPPES |
| 1275960304 | Other | OK | NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Reggie Darnell Pennypacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275960304 PECOS PAC ID: 6709822349 Enrollment ID: I20131126000956 |
| Provider Name | Tonya Bardsher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932627387 PECOS PAC ID: 1658607650 Enrollment ID: I20190730000331 |
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