Provider Demographics
NPI:1144183740
Name:PENNY, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:PENNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13419 DURHAM LN
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-1801
Mailing Address - Country:US
Mailing Address - Phone:228-818-9620
Mailing Address - Fax:
Practice Address - Street 1:3603 BIENVILLE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5736
Practice Address - Country:US
Practice Address - Phone:228-818-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-09
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse