Basic Information
| Provider Information | |||||||||
| NPI: | 1629299557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEPPARD | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PEPPARD | ||||||||
| OtherFirstName: | JANET | ||||||||
| OtherMiddleName: | M. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3367 BLOOMING GROVE RD | ||||||||
| Address2: | |||||||||
| City: | WOODLAWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371919315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315526786 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1021 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370583302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312325329 | ||||||||
| FaxNumber: | 9312327247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 41931 | TN | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 41931 | 01 | TN | RN | OTHER |