Provider Demographics
NPI:1033581665
Name:PEGUES, DEMETRICA STOKES (FNP)
Entity Type:Individual
Prefix:
First Name:DEMETRICA
Middle Name:STOKES
Last Name:PEGUES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-3468
Mailing Address - Country:US
Mailing Address - Phone:662-473-5242
Mailing Address - Fax:662-473-4191
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3468
Practice Address - Country:US
Practice Address - Phone:662-473-5242
Practice Address - Fax:662-473-4191
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR901345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily