Healthcare Provider Details

I. General information

NPI: 1386603280
Provider Name (Legal Business Name): PEGGY S CARGIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SW 2ND AVE
AVA MO
65608-0000
US

IV. Provider business mailing address

PO BOX 865
AVA MO
65608-0865
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-6790
  • Fax: 417-683-6770
Mailing address:
  • Phone: 417-683-6790
  • Fax: 417-683-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAK762
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2000143704
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: