Provider Demographics
NPI:1497758163
Name:STATON, PEGGY (FNP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:
Last Name:STATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2260
Practice Address - Fax:423-857-2261
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5238363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908271Medicaid
TN3908279Medicaid
VA010118042Medicaid
TN3908279Medicaid
VAP00006307Medicare PIN
TN0281780003Medicare PIN
TN103I086169Medicare UPIN
TN0281780001Medicare PIN
VA010118042Medicaid
TN3908271Medicaid
VACA0736Medicare PIN