Provider Demographics
NPI:1790026128
Name:MATHIS, PEGGY JEAN (RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:JEAN
Last Name:MATHIS
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:STE 101
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5626
Mailing Address - Country:US
Mailing Address - Phone:254-200-9355
Mailing Address - Fax:
Practice Address - Street 1:4520 E CENTRAL TEXAS EXPY
Practice Address - Street 2:STE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5626
Practice Address - Country:US
Practice Address - Phone:254-200-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX519582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily