Provider Demographics
NPI:1922719806
Name:ISAAC, PEGGY (CNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 RANCH DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4623
Mailing Address - Country:US
Mailing Address - Phone:501-410-1196
Mailing Address - Fax:501-410-1148
Practice Address - Street 1:2504 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2536
Practice Address - Country:US
Practice Address - Phone:501-410-1196
Practice Address - Fax:501-410-1148
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner