Peggy A Defoure

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AO1686 Issued in AR

Practice address

600 South Timberlane
El Dorado, AR 71730

Phone

(870) 864-8120

NPI assigned

May 11, 2006

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 14, 2012.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1922058858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 EAST 19TH STREET",
            "address_2": "APT E7",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "71730",
            "telephone_number": "479-713-7115",
            "fax_number": "479-713-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SOUTH TIMBERLANE",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "71730",
            "telephone_number": "870-864-8120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFOURE",
        "first_name": "PEGGY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "AO1686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE",
            "identifier": "5Y648",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven Robert Davis, CRNA
• Dayspring Services of Arkansas LLC
• Debra Faulkner
• Debra Faulkner
• Jacob A Defee, LPC
• Joseph A Deluca, MD
• Richard Edward Dietzen, M.D.
• Rebekah Marie Dixon, LCSW
• Rodney M. Dixon, M.D.
• Harvinder S Dod, MD

• All providers in El Dorado, AR
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.