Provider Demographics
NPI:1619669959
Name:PEGUES, AIRREAL (MS)
Entity Type:Individual
Prefix:
First Name:AIRREAL
Middle Name:
Last Name:PEGUES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7891 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4424
Mailing Address - Country:US
Mailing Address - Phone:662-548-1794
Mailing Address - Fax:
Practice Address - Street 1:7891 CHARLESTON DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4424
Practice Address - Country:US
Practice Address - Phone:662-548-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula