Provider Demographics
NPI:1902135536
Name:PEDEN, DEBRA (CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:PEDEN
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-3213
Mailing Address - Country:US
Mailing Address - Phone:662-335-9283
Mailing Address - Fax:662-334-6989
Practice Address - Street 1:1214 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3213
Practice Address - Country:US
Practice Address - Phone:662-335-9283
Practice Address - Fax:662-334-6989
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR668443163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant