Healthcare Provider Details

I. General information

NPI: 1558091587
Provider Name (Legal Business Name): SARAH CALUMBINE PEGOUSKIE APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH CALUMBINE PEGOUSKIE APRN, FNP

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6134 CHENA HOT SPRINGS RD
FAIRBANKS AK
99712-3609
US

IV. Provider business mailing address

6134 CHENA HOT SPRINGS RD
FAIRBANKS AK
99712-3609
US

V. Phone/Fax

Practice location:
  • Phone: 907-799-1812
  • Fax:
Mailing address:
  • Phone: 907-799-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number196730
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP095433
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163754
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296823
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number163754
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: