Provider Demographics
NPI:1740286939
Name:POWELL, PEGGIE L (DNP FNP-BC)
Entity type:Individual
Prefix:
First Name:PEGGIE
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:DNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 N MECKLENBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-4080
Mailing Address - Country:US
Mailing Address - Phone:434-584-2273
Mailing Address - Fax:434-584-5517
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:434-584-2273
Practice Address - Fax:434-584-5517
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166112363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010105013OtherVA PREMIER
VA010105013Medicaid
VAP00362126OtherCC RR MEDICARE
VA010104998Medicaid
VA010252849Medicaid
VA010252849Medicaid
VA006897S75Medicare PIN
VAP00362126OtherCC RR MEDICARE
VA493869Medicare Oscar/Certification
VAQ38119Medicare UPIN
VA010105013Medicaid
VA493833Medicare Oscar/Certification