Provider Demographics
NPI:1689402141
Name:PENLEY, ADAM SETH (PA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:SETH
Last Name:PENLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2635
Mailing Address - Country:US
Mailing Address - Phone:423-220-6897
Mailing Address - Fax:
Practice Address - Street 1:1503 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2635
Practice Address - Country:US
Practice Address - Phone:423-220-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant