Provider Demographics
NPI:1639870678
Name:PEPPERS, KYAUN
Entity Type:Individual
Prefix:
First Name:KYAUN
Middle Name:
Last Name:PEPPERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KYAUN
Other - Middle Name:
Other - Last Name:PEPPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 MINCHEW ST SE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-6519
Mailing Address - Country:US
Mailing Address - Phone:252-292-4559
Mailing Address - Fax:
Practice Address - Street 1:400 MINCHEW ST SE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-6519
Practice Address - Country:US
Practice Address - Phone:252-292-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist