Healthcare Provider Details

I. General information

NPI: 1275597601
Provider Name (Legal Business Name): PEGGY LEA LEWIS BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PEGGY LEA LESTER BSN

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST KAFB
BILOXI MS
39534-2508
US

IV. Provider business mailing address

9121 RAINWOOD CIR
GULFPORT MS
39503-6127
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6985
  • Fax:
Mailing address:
  • Phone: 228-896-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number538251
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: