Provider Demographics
NPI:1750472601
Name:ORR, PEGGY ANN (ANP MSN)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:ORR
Suffix:
Gender:F
Credentials:ANP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5954 RIVERBEND PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1046
Mailing Address - Country:US
Mailing Address - Phone:817-446-0400
Mailing Address - Fax:
Practice Address - Street 1:787 E FM 1187
Practice Address - Street 2:STE A
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4357
Practice Address - Country:US
Practice Address - Phone:817-293-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245455363L00000X, 363LA2200X
TX038568921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB135983Medicare PIN
TXTXB135982Medicare PIN
TXTXB135984Medicare PIN