Provider Demographics
NPI:1164144473
Name:PEOPLES, JOYCE FAY
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:FAY
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11008 STATE HIGHWAY 154 E
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:TX
Mailing Address - Zip Code:75640-3712
Mailing Address - Country:US
Mailing Address - Phone:903-918-7191
Mailing Address - Fax:
Practice Address - Street 1:3940 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-2402
Practice Address - Country:US
Practice Address - Phone:903-918-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02114999OtherDRIVER LICENSE