Healthcare Provider Details

I. General information

NPI: 1912993510
Provider Name (Legal Business Name): PEGGY S. PHILLIPS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 08/12/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LINCOLN ST.
GRAFTON WV
26354
US

IV. Provider business mailing address

333 LINCOLN ST.
GRAFTON WV
26354
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-7900
  • Fax: 304-265-7901
Mailing address:
  • Phone: 304-265-7900
  • Fax: 304-265-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30549
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: