MEDICARE: MRS. KERRIE PEACOCK-PRESTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9103213	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861454126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRIE PEACOCK-PRESTON PA-C

Provider Business Mailing Address
First Line	:	921 NORTH DAVIS ST
Second Line	:	BUILDING A, SUITE 251
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209
Country	:	US
Telephone Number	:	904-253-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W 6TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4324
Country	:	US
Telephone Number	:	904-253-1639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	05/02/2025

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Directions to “ MRS. KERRIE PEACOCK-PRESTON PA-C” Practice Location

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