Provider Demographics
NPI:1700380383
Name:PEYTON, KELEE SUN LOU
Entity Type:Individual
Prefix:
First Name:KELEE
Middle Name:SUN LOU
Last Name:PEYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEL
Other - Middle Name:
Other - Last Name:PEYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:774 PRIOR HALL
Mailing Address - Street 2:376 WEST 10TH AVENUE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-3570
Mailing Address - Fax:
Practice Address - Street 1:774 PRIOR HALL
Practice Address - Street 2:376 WEST 10TH AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-48565207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program