Individual
MRS. PEGGY KISER HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1614 NC HIGHWAY 56, CREEDMOOR, NC 27522-8297
(919) 528-7171
(919) 528-8797
Mailing address
121 MARINA RD, BRACEY, VA 23919-3203
(436) 636-5482
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
100789
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE NUMBER
100789
NC
Enumeration date
07/24/2006
Last updated
03/07/2023
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