Provider Demographics
NPI:1073663167
Name:PEGUES, KIMBERLY DENISE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:PEGUES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WHEAT GRASS WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4138
Mailing Address - Country:US
Mailing Address - Phone:678-362-0570
Mailing Address - Fax:
Practice Address - Street 1:3869 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3918
Practice Address - Country:US
Practice Address - Phone:678-635-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily