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NPI Code Detail

MEDICARE: PEGGY A PRESNELL RD

MEDICARE: PEGGY A PRESNELL RD
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
1133V00000XRegistered Dietitian2000172540MO

General Provider Information

NPI Number : 1871520825
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY A PRESNELL RD
Provider Business Mailing Address
First Line : 611 W MAIN ST
Second Line :
City : FREDERICKTOWN
State : MO
Zip : 63645-1111
Country : US
Telephone Number : 573-783-3341
Fax Number : 573-783-1096
Provider Business Practice Location Address
First Line : 611 W MAIN ST
Second Line :
City : FREDERICKTOWN
State : MO
Zip : 63645-1111
Country : US
Telephone Number : 573-783-3341
Fax Number : 573-783-1096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 06/05/2015

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Directions to “ PEGGY A PRESNELL RD” Practice Location

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