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General NPI Number Information
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NPI Number | 1922719806
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Entity Type | Individual
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Provider Name | PEGGY ISAAC CNP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 2504 W MAIN ST STE A
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2536
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Country | US
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Telephone | 501-410-1196
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Fax | 501-410-1148
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Provider Business Mailing Address
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Address Line | 6315 RANCH DR
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City | LITTLE ROCK
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State | AR
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Zip | 72223-4623
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Country | US
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Telephone | 501-410-1196
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Fax | 501-410-1148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 221843
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License Number State | AR
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