NPIMap

Organization Active NPI

Reggie Pennypacker, Aprn-CNP, PLLC

  • Rural Health Clinic/Center
  • Duncan, OK
National Provider Identifier
1013578954
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
REGGIE PENNYPACKER, APRN-CNP, PLLC
Practice address
3125 Brookwood Ave
Duncan, OK 73533-1362
Phone
(580) 786-4018
Fax
(580) 786-4018
NPI assigned
Jun 21, 2019
Last updated
Apr 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Reggie Darnell Pennypacker, APRN-CNPNPI 1275960304
Title
Nurse Practitioner
Phone
(580) 656-6661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

3125 Brookwood Ave
Duncan, OK 73533-1362

Mailing address

3125 Brookwood Ave
Duncan, OK 73533-1362
Phone (580) 786-4018

Other identifiers 1

IdentifierTypeStateIssuer
1275960304OtherOKNPI NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190801001353 OK Part B Supplier - Clinic/Group Practice 2668708371 Receives reassigned benefits from 4 practitioners
Practice locations: Duncan, OK
O20241015000569 OK Part A Provider - Rural Health Clinic 2668708371 Practice locations: Duncan, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013578954. Details of each certification follow.

Rural health clinic certification: CCN 373913

Legal name
REGGIE PENNYPACKER, APRN-CNP, PLLC
Doing business as
PENNYPACKER FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 7, 2025
Last certification
Feb 7, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jul 18, 2019 in OK
Enrollment address
3125 Brookwood Ave
Duncan, OK 73533-1362

National Provider Directory

National Provider Directory

Locations

1611 N Brookwood Dr
Duncan, OK 73533
Phone (580) 786-4018

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Miguel R Sabedra Individual Corporate DirectorMedical Director Aug 1, 2019
Julie R Pennypacker Individual 5% Or Greater Direct Ownership InterestOwner Jul 19, 2021 49%
W-2 Managing EmployeeAd; Jul 19, 2021
Reggie Darnell Pennypacker Individual 5% Or Greater Direct Ownership InterestOwner Jul 18, 2021 51%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745539200000",
    "number": "1013578954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 BROOKWOOD AVE",
            "city": "DUNCAN",
            "state": "OK",
            "postal_code": "735331362",
            "telephone_number": "580-786-4018",
            "fax_number": "580-786-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 BROOKWOOD AVE",
            "city": "DUNCAN",
            "state": "OK",
            "postal_code": "735331362",
            "telephone_number": "580-786-4018",
            "fax_number": "580-786-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGGIE PENNYPACKER, APRN-CNP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-21",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A",
        "authorized_official_last_name": "PENNYPACKER",
        "authorized_official_first_name": "REGGIE",
        "authorized_official_middle_name": "DARNELL",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "580-656-6661",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "APRN-CNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1275960304",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duncan, OK

Sources for this page

Verify at the official NPI Registry.