Healthcare Provider Details

I. General information

NPI: 1154161891
Provider Name (Legal Business Name): KENDRA MARIE PEGG BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA MARIE PRICE BA

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 3RD AVE
WILLIAMSON WV
25661-3006
US

IV. Provider business mailing address

1500 W 5TH AVE APT 8
WILLIAMSON WV
25661-3457
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-0026
  • Fax: 304-235-0028
Mailing address:
  • Phone: 859-779-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: