Provider Demographics
NPI:1275597601
Name:LEWIS, PEGGY LEA (BSN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LEA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:LEA
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:9121 RAINWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6127
Mailing Address - Country:US
Mailing Address - Phone:228-896-4983
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:KAFB
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:228-377-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538251163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory