Susan Kay Pennypacker, FNP C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

6966 Issued in TN

Practice address

140 Old Gray Station Rd
Suite 200
Gray, TN 37615

Phone

(423) 477-2042

Fax

(423) 477-7571

NPI assigned

Aug 16, 2005

Last updated

Nov 8, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Pediatrics, LLC

  • Nurse Practitioner
  • Gray, TN
  • NPI 1821497942
  NPD (past) Authorized official

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1194717157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 OLD GRAY STATION RD",
            "address_2": "SUITE 200",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "37615",
            "telephone_number": "423-477-2042",
            "fax_number": "423-477-7571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 OLD GRAY STATION RD",
            "address_2": "SUITE 200",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "37615",
            "telephone_number": "423-477-2042",
            "fax_number": "423-477-7571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYPACKER",
        "first_name": "SUSAN",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "FNP C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "6966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440517",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig Paul Moorhouse, ATC
• Sarah Morgan, DPT
• Leah Moseley
• Mountain Wings; LLC
• Elizabeth Brezina Palmer, MD
• Emily Dawn Peters, L.M.T.
• Premier Wound Care of Tennessee, PC
• Providence Pediatrics, LLC
• William Machenzie Rasnick, PHARMD
• Joseph K Reid, P.A.

• Family Nurse Practitioner in Gray, TN
• Providers in Gray, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.