Provider Demographics
NPI:1134429046
Name:PHILLIPS, PEGGY MARIE (RN-BC, ANP-C)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN-BC, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17448 HIGHWAY 3
Mailing Address - Street 2:SUITE 136
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4141
Mailing Address - Country:US
Mailing Address - Phone:281-338-4443
Mailing Address - Fax:281-338-8821
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:SUITE 136
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4197
Practice Address - Country:US
Practice Address - Phone:281-338-4443
Practice Address - Fax:281-338-8821
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1010004363LA2200X
TX518144363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280521003Medicaid
TX280521004Medicaid
TXP01197024OtherMEDICARE RR
TX832N36OtherBLUE CROSS BLUE SHIELD
TX1134429046OtherBLUE CROSS BLUE SHIELD
TX280521001Medicaid
TX280521002Medicaid
TXP00988009OtherRAILROAD MEDICARE
TX401060YMVQMedicare PIN
TXP01197024OtherMEDICARE RR
TX280521003Medicaid