Healthcare Provider Details

I. General information

NPI: 1184340127
Provider Name (Legal Business Name): JESSICA LOUISE PECKHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 CREEKSTONE DR FL 4
DURHAM NC
27703-0107
US

IV. Provider business mailing address

117 STERLING CHAPEL WAY
CHAPEL HILL NC
27517-9607
US

V. Phone/Fax

Practice location:
  • Phone: 919-613-9919
  • Fax: 919-385-9279
Mailing address:
  • Phone: 919-805-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number238559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: