Provider Demographics
NPI:1558091587
Name:PEGOUSKIE, SARAH CALUMBINE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CALUMBINE
Last Name:PEGOUSKIE
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:CALUMBINE
Other - Last Name:PEGOUSKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:1099 TENA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1422
Mailing Address - Country:US
Mailing Address - Phone:989-390-2962
Mailing Address - Fax:
Practice Address - Street 1:1717 W COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5926
Practice Address - Country:US
Practice Address - Phone:907-451-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP095433146L00000X
AK163754163WC0200X, 163W00000X
NC296823163W00000X
AK196730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse