Provider Demographics
NPI:1366874745
Name:DENTON, PEGGY E (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:E
Last Name:DENTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:435-979-0857
Mailing Address - Fax:
Practice Address - Street 1:3823 NATIONAL PARKS HIGHWAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-8822
Practice Address - Country:US
Practice Address - Phone:575-689-1456
Practice Address - Fax:575-689-1457
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02234207Q00000X
UT338092-8900207Q00000X
UT338092-4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72328266Medicaid
NM72328266Medicaid