Provider Demographics
NPI:1720185531
Name:DESCAMPS, PEGGY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LYNN
Last Name:DESCAMPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:280 FORT SANDERS WEST BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3352
Practice Address - Country:US
Practice Address - Phone:865-539-0270
Practice Address - Fax:865-539-6998
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029940Medicaid