Provider Demographics
NPI:1881650117
Name:BIRKENFELD, PEGGY (FNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BIRKENFELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HALSELL ST
Mailing Address - Street 2:
Mailing Address - City:DIMMITT
Mailing Address - State:TX
Mailing Address - Zip Code:79027-1846
Mailing Address - Country:US
Mailing Address - Phone:806-647-8780
Mailing Address - Fax:806-647-3769
Practice Address - Street 1:300 W HALSELL ST
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027-1846
Practice Address - Country:US
Practice Address - Phone:806-647-8780
Practice Address - Fax:806-647-3769
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146595002Medicaid
TX00N49AOtherBCBS
TX00N49AOtherMEDICARE PART B
TX063566602Medicaid
TX063566601Medicaid
TX458679OtherGROUP MEDICARE
P42306Medicare UPIN
TX8C9374Medicare UPIN