Provider Demographics
NPI:1275944720
Name:PEEPLES, KATIE CORBETT (CRNA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CORBETT
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEIGH
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6533
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2014-05-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX787924163W00000X
TXAP125942367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8727UHOtherBCBS
TX342786601Medicaid
TXP01445907OtherRAILROAD
TX342786601Medicaid