1538344064 NPI number — PEGGY HILL SHELBY FNP

Table of content: PEGGY HILL SHELBY FNP (NPI 1538344064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538344064 NPI number — PEGGY HILL SHELBY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELBY
Provider First Name:
PEGGY
Provider Middle Name:
HILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538344064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
528 OLD RICHBURG RD
Provider Second Line Business Mailing Address:
P O BOX 414
Provider Business Mailing Address City Name:
PURVIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39475-7801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-794-5045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6440 SOUTH MILLROCK DR SUITE 175
Provider Second Line Business Practice Location Address:
COMP HEALTH
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-634-9583
Provider Business Practice Location Address Fax Number:
866-588-1339
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R727296 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP3282 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CG7880 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 411368 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05851267 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com