Healthcare Provider Details

I. General information

NPI: 1871458950
Provider Name (Legal Business Name): CASEY ELIZABETH PEEBLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 BOXER LN
FRIES VA
24330-3673
US

IV. Provider business mailing address

79 BOXER LN
FRIES VA
24330-3673
US

V. Phone/Fax

Practice location:
  • Phone: 276-237-4913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number421966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: