Doctor Name: | DEMETRICA STOKES PEGUES |
NPI Number: | 1033581665 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R901345 |
Business Practice Address: | 604 S Main St Water Valley, MS - 389653468 |
Business Phone Number: | 6624735242 |
Business Fax Number: | 6624734191 |
Mailing Address: | 604 S Main St, WATER VALLEY |
State: | MS |
Postal Code: | 389653468 |
Phone Number: | 6624735242 |
Fax Number: | 6624734191 |
NPI Enumeration Date: | 10/22/2015 |
NPI Last Update Date: | 10/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R901345 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |