Peggy J Davidson, CRNP

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

249499 Issued in TX

Practice address

455 Rice Rd Ste 108
#108
Tyler, TX 75703-3604

Phone

(903) 939-0799

Fax

(903) 939-0799

NPI assigned

Aug 9, 2006

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

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23550/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Diagnostic Clinic of Longview PA

  • Internal Medicine Physician
  • Longview, TX
  • NPI 1386638468
  NPD (past)
• East Texas Alf Waterton Inn LLC

  • Assisted Living Facility
  • Tyler, TX
  • NPI 1497020853
  NPD (past)
• Hsmtx/Waterton Inn, LLC

  dba The Waterton Inn Assisted Living

  • Assisted Living Facility
  • Tyler, TX
  • NPI 1528242617
  NPD (past)
• Janis Bargfeldt Care Associates, LLC

  • Gerontology Nurse Practitioner
  • Murchison, TX
  • NPI 1528382876
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218499200000",
    "number": "1679583793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 FENTON RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756041119",
            "telephone_number": "903-939-0799",
            "fax_number": "903-939-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 RICE RD STE 108",
            "address_2": "#108",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033604",
            "telephone_number": "903-939-0799",
            "fax_number": "903-939-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "PEGGY",
        "middle_name": "J",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "TX",
            "license": "249499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175568801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David a. Andreone DPM PLLC
• David a. Wilkinson DDS MSD, P.a. (Sherman Briscoe Wilkinson Orthodontics)
• David K Fletcher MD PA
• David W Ball MD Internal Medicine PLLC
• Julie Kathryn David, LPC
• Randy Davidson, PHARM.D.
• Ashley Marie Davis, M.A. LPC
• Blaise Davis, FNP-C, FNP-BC
• Brandi Davis
• Brent O'Bryan Davis, MD

• Licensed Practical Nurse in Tyler, TX
• Providers in Tyler, TX by specialty
• Licensed Practical Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; 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.