Provider Demographics
NPI:1215966791
Name:PENNY, KATHY A (ANP, GNP-BC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:PENNY
Suffix:
Gender:F
Credentials:ANP, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-3691
Mailing Address - Fax:585-368-3337
Practice Address - Street 1:55 GENESEE ST BK BUILDING 1ST FLR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611
Practice Address - Country:US
Practice Address - Phone:585-368-3591
Practice Address - Fax:585-368-3620
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304409363LA2200X
NYF340536363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02507591Medicaid
NYJ400025535/GRPBA0017Medicare PIN