Provider Demographics
NPI:1477041804
Name:ROBERTS, PEGGY JO (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY JO
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-C
Other - Prefix:MS
Other - First Name:PEGGY JO
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:932 COUNTY ROAD 150
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:AL
Mailing Address - Zip Code:35963-3303
Mailing Address - Country:US
Mailing Address - Phone:256-558-7609
Mailing Address - Fax:
Practice Address - Street 1:3442 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0203
Practice Address - Country:US
Practice Address - Phone:256-907-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272698163W00000X
AL1-118016163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse