Provider Demographics
NPI:1386603280
Name:CARGIN, PEGGY S (FNP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:S
Last Name:CARGIN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-0865
Mailing Address - Country:US
Mailing Address - Phone:417-683-6790
Mailing Address - Fax:417-683-6770
Practice Address - Street 1:120 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-0000
Practice Address - Country:US
Practice Address - Phone:417-683-6790
Practice Address - Fax:417-683-6770
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK762363LF0000X
MO2000143704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01999Medicare UPIN
MO000012617Medicare PIN
MO126170001Medicare PIN