Provider Demographics
NPI:1336816040
Name:BEACH, PEGGY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4722 TAFT BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4800
Mailing Address - Country:US
Mailing Address - Phone:940-264-2625
Mailing Address - Fax:940-264-6401
Practice Address - Street 1:4722 TAFT BLVD STE 8
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4800
Practice Address - Country:US
Practice Address - Phone:940-264-2625
Practice Address - Fax:940-264-6401
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052551207RI0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty