Basic Information
| Provider Information | |||||||||
| NPI: | 1679078489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSSON | ||||||||
| FirstName: | PEGGY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9755 W STATE HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729519000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794312050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9755 W STATE HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729519000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794312050 | ||||||||
| FaxNumber: | 4794312051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A005526 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.