MEDICARE: SYDNEY PECK RN

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	163W00000X	Registered Nurse	213619	AR

General Provider Information

NPI Number	:	1922961119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY PECK RN

Provider Business Mailing Address
First Line	:	320 E PARKWAY DR
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 E PARKWAY DR
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3916
Country	:	US
Telephone Number	:	607-438-0734
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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