Provider Demographics
NPI:1033119235
Name:JARVIS, PEGGY P (WHCNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:P
Last Name:JARVIS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:WISH TUBAL CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-5306
Practice Address - Fax:214-590-2798
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246240363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041564808Medicaid
TX8N4798OtherBLUE CROSS BLUE SHIELD
TX041564813Medicaid
TX041564802Medicaid
TX041564805Medicaid
TX041564806Medicaid
TX041564807Medicaid
TX041564809Medicaid
TX041564810Medicaid
TX041564811Medicaid
TX041564803Medicaid
TX041564812Medicaid
TX041564804Medicaid
TX041564805Medicaid
TX041564809Medicaid