Healthcare Provider Details

I. General information

NPI: 1386506632
Provider Name (Legal Business Name): MRS. PEGGY AILEEN VILLA RECCION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD
CLARKSVILLE TN
37043-8849
US

IV. Provider business mailing address

215 DUNBAR CAVE RD
CLARKSVILLE TN
37043-8849
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2739
  • Fax: 931-233-9970
Mailing address:
  • Phone: 931-542-2739
  • Fax: 931-233-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: