Penny Marie Holley, FNP
Individual provider Active NPI Family Nurse Practitioner · Southaven, MS
NPI 1013524495 · NPPES record last updated Mar 1, 2023
Key facts
- NPI
- 1013524495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 868493 (MS)
- Practice address
- 3964 Goodman Rd E Ste 128-129
Southaven, MS 38672-8761 - Phone
- (662) 655-0456
- Fax
- (662) 655-0457
- NPI assigned
- Sep 29, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Convenient Care Clinic LLC
Practice addresses (Care Compare)
3040 Goodman Rd W
Horn Lake, MS 38637-1189
Phone (662) 280-3428
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201112002857 | MS | Practitioner - Nurse Practitioner | 4082024492 | Reassigns benefits to 2 organizations |
| I20260526000459 | TN | Practitioner - Nurse Practitioner | 4082024492 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 868493 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Convenient Care Clinic, LLC | Family | Current |
Accepting new patients |
| Convenient Care Clinic, LLC | Family | Current |
Accepting new patients |
| Mays Medical Wellness, LLC | Current |
Accepting new patients | |
| Horn Lake Chiropractic Centre, Inc. | Past |
Accepting new patients |
Locations
555 Highway 6 E
Batesville, MS 38606
Phone (662) 578-2030
3040 Goodman Rd W
Horn Lake, MS 38637
Phone (662) 230-3420
5142 Goodman Rd
Ste 107
Olive Branch, MS 38654
Phone (662) 874-5755
3964 Goodman Rd E
Ste 128
Southaven, MS 38672
Phone (662) 420-7350
3964 Goodman Rd E
Ste 128129
Southaven, MS 38672
Phone (662) 655-0456
Interoperability endpoints
- https://api.platform.athenahealth.com/16886/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 868493 | MS | Yes |
Addresses
Primary practice location
3964 Goodman Rd E Ste 128-129
Southaven, MS 38672-8761
Mailing address
3964 Goodman Rd E Ste 128-129
Southaven, MS 38672-8761
Phone (662) 655-0456
Other providers in Southaven, MS
- Stacy L Holder
- Robert Sterling Hollabaugh Jr.
- Holland Initiative, Inc.
- April A Holland
- Peyton G Holland
- Alane Furlotte Holliday
- Joshua Kermit Hollingsworth
- Erica P Holmes
- Home Care Solutions, Inc.
- David A Hooker
All providers in Southaven, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.