Peggy A Ottey, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R149658 Issued in MD

Practice address

Ideal Option
47 Virginia Avenue
Cumberland, MD 21502

Phone

(301) 268-5903

Fax

(509) 491-3031

NPI assigned

Dec 11, 2007

Last updated

Jan 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1336322544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 VIRGINIA AVE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215023964",
            "telephone_number": "301-268-5903",
            "fax_number": "509-491-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "IDEAL OPTION",
            "address_2": "47 VIRGINIA AVENUE",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "21502",
            "telephone_number": "301-268-5903",
            "fax_number": "509-491-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTEY",
        "first_name": "PEGGY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-11",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R149658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028465300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Cumberland, MD
• Providers in Cumberland, MD by specialty
• Adult Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.