Provider Demographics
NPI:1417192931
Name:PEGGINS, KRISTIE NEICHALL (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:NEICHALL
Last Name:PEGGINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:NEICHALL
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 1000
Mailing Address - Street 2:DEPT 960
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148
Mailing Address - Country:US
Mailing Address - Phone:901-272-6030
Mailing Address - Fax:901-516-8450
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 365
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-272-6030
Practice Address - Fax:901-516-8450
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14284363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514067Medicaid
TN1514067Medicaid