Healthcare Provider Details

I. General information

NPI: 1013971639
Provider Name (Legal Business Name): PEGGY A HAYS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CENTRAL AVE
MAYFIELD KY
42066-3115
US

IV. Provider business mailing address

416 CENTRAL AVE
MAYFIELD KY
42066-3115
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-3553
  • Fax: 270-247-3553
Mailing address:
  • Phone: 270-247-3553
  • Fax: 270-247-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3002969
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1035212
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: