MEDICARE: MRS. PEGGY S. PHILLIPS NP

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
1	363LF0000X	Family Nurse Practitioner	30549	WV

Other Identifiers

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

General Provider Information

NPI Number	:	1912993510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEGGY S. PHILLIPS NP

Provider Business Mailing Address
First Line	:	333 LINCOLN ST.
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354
Country	:	US
Telephone Number	:	304-265-7900
Fax Number	:	304-265-7901

Provider Business Practice Location Address
First Line	:	333 LINCOLN ST.
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354
Country	:	US
Telephone Number	:	304-265-7900
Fax Number	:	304-265-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/12/2025

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