Provider Demographics
NPI:1467026435
Name:PEAVY, TREANA V (APRN)
Entity Type:Individual
Prefix:
First Name:TREANA
Middle Name:V
Last Name:PEAVY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 BUNKER HILL LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7201
Mailing Address - Country:US
Mailing Address - Phone:513-869-9076
Mailing Address - Fax:513-869-9076
Practice Address - Street 1:9725 BUNKER HILL LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7201
Practice Address - Country:US
Practice Address - Phone:513-869-9076
Practice Address - Fax:513-869-9076
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH435447163WP0808X
OH0035225363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health