Healthcare Provider Details

I. General information

NPI: 1285599860
Provider Name (Legal Business Name): NICOLE PECKINPAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SHARRON AVE
PLATTSBURGH NY
12901-4700
US

IV. Provider business mailing address

79 GLENRIDGE RD
GLENVILLE NY
12302-4528
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-1447
  • Fax: 518-562-8812
Mailing address:
  • Phone: 518-561-1447
  • Fax: 518-562-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number324693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: