| Doctor Name: | MRS. PHYLLIS A. PEACE |
| NPI Number: | 1225434756 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 79303 |
| Business Practice Address: | 12455 E 100th St N Ste 300 Owasso, OK - 740554678 |
| Business Phone Number: | 9182749700 |
| Business Fax Number: | 9182741395 |
| Mailing Address: | 12455 E 100th St N Ste 300, OWASSO |
| State: | OK |
| Postal Code: | 740554678 |
| Phone Number: | 9182749700 |
| Fax Number: | 9182741395 |
| NPI Enumeration Date: | 11/11/2014 |
| NPI Last Update Date: | 11/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 79303 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |