Healthcare Provider Details

I. General information

NPI: 1386798361
Provider Name (Legal Business Name): PEGGY LEWIS THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/31/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 36048 SOLDIER RECOVERY UNIT
FORT HOOD TX
76544
US

IV. Provider business mailing address

1108 HOUSTON ST
KILLEEN TX
76541-7968
US

V. Phone/Fax

Practice location:
  • Phone: 254-287-1607
  • Fax: 287-285-5103
Mailing address:
  • Phone: 254-628-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number673598
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number45899
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number673598
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: