Provider Demographics
NPI:1326236423
Name:WHITAKER, PEGGY D (RN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:D
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PEGGY
Other - Middle Name:D
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:3161 CUSTER DR
Practice Address - Street 2:STE 4
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4067
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1033207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid