Provider Demographics
NPI:1033591169
Name:COSGROVE, PEGGY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3264
Mailing Address - Country:US
Mailing Address - Phone:501-580-0295
Mailing Address - Fax:
Practice Address - Street 1:709 N BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3264
Practice Address - Country:US
Practice Address - Phone:501-580-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1005772133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered