Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1063762847 |
---|---|
Provider Name | Ms. Kara Louise Pegram |
First Address | Joint Base Lewis Mcchord, WA 98431-1000 |
Second Address | Tacoma, WA 98431-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 13/03/2019 |