Provider Demographics
NPI:1801213327
Name:PEAVY, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:PEAVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 BROWN SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-3636
Mailing Address - Country:US
Mailing Address - Phone:843-254-8087
Mailing Address - Fax:
Practice Address - Street 1:729 BROWN SWAMP RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-3636
Practice Address - Country:US
Practice Address - Phone:843-254-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105133163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health