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NPI Code Detail

MEDICARE: MRS. PEGGY KISER HARRIS PA-C

MEDICARE: MRS. PEGGY KISER HARRIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant100789NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LICENSE NUMBEROTHERNC100789

General Provider Information

NPI Number : 1356363089
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PEGGY KISER HARRIS PA-C
Provider Business Mailing Address
First Line : 121 MARINA RD
Second Line :
City : BRACEY
State : VA
Zip : 23919-3203
Country : US
Telephone Number : 436-636-5482
Fax Number :
Provider Business Practice Location Address
First Line : 1614 NC HIGHWAY 56
Second Line :
City : CREEDMOOR
State : NC
Zip : 27522-8297
Country : US
Telephone Number : 919-528-7171
Fax Number : 919-528-8797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 03/07/2023

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