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General NPI Number Information
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NPI Number | 1194592741
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Entity Type | Individual
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Provider Name | TEA PEGUES
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Gender | Female
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 1414 E 39TH ST APT 146
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City | TULSA
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State | OK
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Zip | 74105-3388
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Country | US
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Telephone | 720-557-2947
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Fax |
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Provider Business Mailing Address
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Address Line | 522 W CASHMERE RD
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City | BOISE
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State | ID
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Zip | 83702-1622
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Country | US
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Telephone | 720-557-2947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 5871768
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License Number State | ID
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