Provider Demographics
NPI:1386798361
Name:THOMAS, PEGGY LEWIS (RN)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEWIS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7968
Mailing Address - Country:US
Mailing Address - Phone:254-628-1770
Mailing Address - Fax:
Practice Address - Street 1:BLDG 36048
Practice Address - Street 2:SOLDIER RECOVERY UNIT
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-1607
Practice Address - Fax:287-285-5103
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673598163W00000X, 163WC0400X
HI45899163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty