Healthcare Provider Details

I. General information

NPI: 1023865078
Provider Name (Legal Business Name): PEAK WELLNESS AND AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MOUNT PLEASANT RD STE A
CHESAPEAKE VA
23322-4155
US

IV. Provider business mailing address

221 MOUNT PLEASANT RD STE A
CHESAPEAKE VA
23322-4155
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-9444
  • Fax: 757-447-3500
Mailing address:
  • Phone: 757-312-9444
  • Fax: 757-447-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAIGE C PROCTOR
Title or Position: OWNER
Credential: PA-C
Phone: 757-312-9444