Provider Demographics
NPI:1205837309
Name:PEECH, DEBORAH T (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:T
Last Name:PEECH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0839
Mailing Address - Country:US
Mailing Address - Phone:270-685-7150
Mailing Address - Fax:270-685-7173
Practice Address - Street 1:1000 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0839
Practice Address - Country:US
Practice Address - Phone:270-685-7150
Practice Address - Fax:270-685-7173
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003576363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200382450Medicaid
KY7800611100Medicaid
KY000000542446OtherBCBS# - CHS, INC.
KY000000542446OtherBCBS# - CHS, INC.
P39429Medicare UPIN
KY7800611100Medicaid