Provider Demographics
NPI:1942278247
Name:GUARD, PEGGY KENLEY (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:KENLEY
Last Name:GUARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:KENLEY
Other - Last Name:GUARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9501 BAPTIST HEALTH DR
Mailing Address - Street 2:STE 777
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6225
Mailing Address - Country:US
Mailing Address - Phone:501-801-7900
Mailing Address - Fax:501-801-7905
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:STE 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-978-4340
Practice Address - Fax:501-227-5187
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC 8487207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123882001Medicaid
AR5J203Medicare ID - Type UnspecifiedMEDICARE
AR123882001Medicaid