MEDICARE: PEGGY WREN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP132010	TX
2	363LF0000X	Family Nurse Practitioner	A005118	AR

General Provider Information

NPI Number	:	1225560162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY WREN APRN

Provider Business Mailing Address
First Line	:	704 W GROVE ST STE 3
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4469
Country	:	US
Telephone Number	:	870-875-5577
Fax Number	:	870-875-5507

Provider Business Practice Location Address
First Line	:	704 W GROVE ST STE 3
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730
Country	:	US
Telephone Number	:	870-875-5577
Fax Number	:	870-875-5507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	04/19/2026

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Directions to “ PEGGY WREN APRN” Practice Location

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