Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Kristina Renee Pegram, MSCCC-SLP

Individual provider Rehabilitation Practitioner · NPI 1215110275

MS. Kristina Renee Pegram, MSCCC-SLP is a Qualified Speech Language Pathologist in Yorktown, Virginia. Qualified in 2004, 22 years ago. Practices with Functional Pathways Preferred of Tennessee LLC, a 192-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
22
Licensed in
VA
In the registry since
2007
Specialties on file
2

Practice location Address checks out

3540 Victory Blvd
Yorktown, VA 23693
Phone: (757) 776-0736
Fax: (757) 776-0737
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1485 International Pkwy, Heathrow, FL 32746-5303 — (800) 798-6035

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 2202004684 (VA)
Rehabilitation Practitioner Taxonomy 225400000X · Licence 2202004684 (VA)

Record details

NPI number1215110275
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSCCC-SLP
Sole proprietorNo
NPI enumeratedDecember 13, 2007
Last updated in NPPESJuly 3, 2024
Certification dateJuly 3, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Functional Pathways Preferred Of Tennessee Llc — 192 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare