Healthcare Provider Details

I. General information

NPI: 1760305551
Provider Name (Legal Business Name): STEPHANIE PEGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S L ROGERS WELLS BLVD
GLASGOW KY
42141-1725
US

IV. Provider business mailing address

212 W BROWN ST
GLASGOW KY
42141-2134
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2372
  • Fax:
Mailing address:
  • Phone: 304-771-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberP17-979-697
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: