Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2020002762 | MO |
N | 111NI0900X | Internist | 2020002762 | MO |
Y | 207RA0201X | Internist - Allergy & Immunology | 2020002762 | MO |
NPI | 1306938725 |
---|---|
Provider Name | Dr. Peggy Lynn Kendall |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200080962 | (05) | MO |
I24584 | (02) |