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General NPI Number Information
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NPI Number | 1053818922
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Entity Type | Individual
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Provider Name | MICHELLE BAISDEN PECK
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 7714 CONNER RD STE 101
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City | POWELL
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State | TN
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Zip | 37849-3559
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Country | US
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Telephone | 865-212-6441
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Fax | 865-212-6446
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Provider Business Mailing Address
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Address Line | 7714 CONNER RD STE 101
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City | POWELL
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State | TN
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Zip | 37849-3559
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Country | US
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Telephone | 865-212-6441
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Fax | 865-212-6446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APN23943
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License Number State | TN
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