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NPI Code Detail

MEDICARE: MRS. PEGGY LYNN DESCAMPS PA-C

MEDICARE: MRS. PEGGY LYNN DESCAMPS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA0000000186TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720185531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PEGGY LYNN DESCAMPS PA-C
Provider Business Mailing Address
First Line : 1275 DICK LONAS RD UNIT 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37909-1383
Country : US
Telephone Number : 865-584-4747
Fax Number : 865-584-1363
Provider Business Practice Location Address
First Line : 280 FORT SANDERS WEST BLVD STE 101
Second Line :
City : KNOXVILLE
State : TN
Zip : 37922-3352
Country : US
Telephone Number : 865-539-0270
Fax Number : 865-539-6998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 03/02/2020

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