Healthcare Provider Details

I. General information

NPI: 1679078489
Provider Name (Legal Business Name): PEGGY ROSSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 W STATE HIGHWAY 22
RATCLIFF AR
72951-9000
US

IV. Provider business mailing address

9755 W STATE HIGHWAY 22
RATCLIFF AR
72951-9000
US

V. Phone/Fax

Practice location:
  • Phone: 479-431-2050
  • Fax: 479-431-2051
Mailing address:
  • Phone: 479-431-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005526
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: