KRISTIN M PECK (NPI# 1487924098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487924098 |
| Entity Type | Individual |
| Full Name | KRISTIN M PECK |
| Credential | PA-C |
| Practice Address |
1836 E 15th St Tulsa OK 74104-4611 |
| Practice Telephone | 9185855658 |
| Practice Fax Number | 9185855670 |
| Mailing Telephone | 9185855658 |
| Mailing Fax Number | 9185855670 |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2015-11-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
2112 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
OK | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427665363 | Kristin Peck | Specialist/Technologist, Other | 3435 W Cary St, Richmond, VA 23221-2726 | 2020-09-24 |
| 1427656768 | Kristin Peck | Counselor | 30 Old Kings Hwy S, Darien, CT 06820-4551 | 2020-10-09 |
| Street Address |
1836 E 15TH ST |
| City | TULSA |
| State | OK |
| Zip Code | 74104-4611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285737098 | David W Asher | Pain Medicine | 1836 E 15th St, Tulsa, OK 74104 | 2006-09-07 |
| 1164039525 | Genesiscare Landmark Oklahoma Cancer Care PC | Surgery | 1836 E 15th St, Tulsa, OK 74104-4611 | 2020-09-29 |
| 1194215723 | Oklahoma Cancer Specialists and Research Institute, LLC | Surgery | 1836 E 15th St, Tulsa, OK 74104-4611 | 2018-05-18 |
| 1508938374 | Edward Joseph Sutton II | Internal Medicine | 1836 E 15th St, Tulsa, OK 74104 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982253811 | Ultimate Health and Pain Management | Pain Medicine | 1844 East 15th Street, Tulsa, OK 74104 | 2019-09-04 |
| 1225691223 | David Murray | Student in an Organized Health Care Education/Training Program | 2100 S Wheeling Ave, Tulsa, OK 74104 | 2019-04-16 |
| 1083115828 | Susan Fortner | Counselor | 1328 S. Delaware Pl, Tulsa, OK 74104 | 2018-02-27 |
| 1033636915 | Mark Brizendine | Dietitian, Registered | Hillcrest Medical Center 1120 S. Utica Ave, Tulsa, OK 74104 | 2017-08-23 |
| 1295259067 | Demi Reyd Cook | Nurse Practitioner | 1717 A South Utica, Tulsa, OK 74104 | 2017-08-02 |
| 1851827059 | Oklahoma Cvs Pharmacy | Durable Medical Equipment & Medical Supplies | 1701 E 15th Street, Tulsa, OK 74104 | 2017-05-08 |
| 1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
| 1578913430 | Donna Durant-macon | Registered Nurse | 315 South Utica, Tulsa, OK 74104 | 2016-06-21 |
| 1669833851 | Mbc Dental | Dentist | 401 S. Utica Ave, #a, Tulsa, OK 74104 | 2016-03-15 |
| 1518332170 | Neuro Dynamics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 22 S Lewis, Tulsa, OK 74104 | 2015-12-08 |
| Find all providers in zip 74104 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073154647 | Haley Nicole Beaird | Physician Assistant | 8907 E 93rd St, Tulsa, OK 74133-5634 | 2019-10-03 |
| 1790155562 | Caldwell Medical Group of North Tulsa LLC | Physician Assistant | 8014 S 101st East Ave, Tulsa, OK 74133-4579 | 2015-10-05 |
| 1609298330 | Marci Love Deck | Physician Assistant | 2000 S Wheeling Ave Ste 1000, Tulsa, OK 74104-5648 | 2014-01-15 |
| 1619216272 | Nicole Lisette Mancinelli | Physician Assistant | 2424 E. 21st Street, Suite 320, Tulsa, OK 74114 | 2013-02-01 |
| 1184959389 | Erin Nicole Jones | Physician Assistant | 11212 E 48th St., Oklahoma Oncology, Tulsa, OK 74146-5806 | 2009-10-06 |
| 1194901793 | Annamae Kay | Physician Assistant | 1919 South Wheeling Ave, Ste 304, Tulsa, OK 74104 | 2008-01-14 |
| 1265632129 | Oklahoma Occupational Health Center | Physician Assistant | 5640 S Memorial Dr, Tulsa, OK 74145-9001 | 2007-07-19 |
| 1962535831 | Njanja Margaret Ruenji | Physician Assistant | Morton Comprehensive Health Services, 1334 N. Lasing Ave, Tulsa, OK 74106-5907 | 2007-03-13 |
| 1740355460 | Jeri Clark Goen | Physician Assistant | 3807 S Peoria Ave, Suite G and H, Tulsa, OK 74105-3145 | 2006-11-21 |
| 1790879237 | Steven Paul Henry | Physician Assistant | 10506 South Memorial Drive, Tulsa, OK 74133 | 2006-10-02 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.