Provider Demographics
NPI:1427069392
Name:PENNY, HEATHER (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PENNY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE4 200
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9313
Mailing Address - Country:US
Mailing Address - Phone:610-869-4627
Mailing Address - Fax:
Practice Address - Street 1:900 W BALTIMORE PIKE
Practice Address - Street 2:SUITE4 200
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9313
Practice Address - Country:US
Practice Address - Phone:610-869-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000360363A00000X
MDC0002644363A00000X
PAMA003295L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031928280001Medicaid
PA1031928280001Medicaid
MDP00054917OtherRAIL ROAD MEDICARE
DEP14907Medicare UPIN
DEP00054911OtherRAIL ROAD MEDICARE