Provider Demographics
NPI:1316394463
Name:PEEPLES, KEONA
Entity Type:Individual
Prefix:
First Name:KEONA
Middle Name:
Last Name:PEEPLES
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 1:200 W 2ND ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48068-7018
Mailing Address - Country:US
Mailing Address - Phone:586-746-4045
Mailing Address - Fax:
Practice Address - Street 1:200 W 2ND ST UNIT 411
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48068-7018
Practice Address - Country:US
Practice Address - Phone:586-746-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other