Basic Information
| Provider Information | |||||||||
| NPI: | 1417192931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEGGINS | ||||||||
| FirstName: | KRISTIE | ||||||||
| MiddleName: | NEICHALL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOODS | ||||||||
| OtherFirstName: | KRISTIE | ||||||||
| OtherMiddleName: | NEICHALL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P O BOX 1000 | ||||||||
| Address2: | DEPT 960 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012726030 | ||||||||
| FaxNumber: | 9015168450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 EASTMORELAND AVE | ||||||||
| Address2: | SUITE 365 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012726030 | ||||||||
| FaxNumber: | 9015168450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2008 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 14284 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | 14284 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1514067 | 05 | TN | MEDICAID |