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General NPI Number Information
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NPI Number | 1275132136
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Entity Type | Individual
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Provider Name | TINA PECK APRN
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Gender | Female
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 430 S COMMERCE ST STE 300
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City | WICHITA
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State | KS
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Zip | 67202-4600
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Country | US
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Telephone | 316-708-4099
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Fax | 949-209-5494
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Provider Business Mailing Address
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Address Line | 2250 N ROCK RD # 118-266
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City | WICHITA
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State | KS
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Zip | 67226-2331
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Country | US
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Telephone | 316-708-4099
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-77614
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License Number State | KS
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