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General NPI Number Information
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NPI Number | 1487924098
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Entity Type | Individual
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Provider Name | KRISTIN M PECK PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 8921 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74133
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Country | US
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Telephone | 918-252-8060
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Fax | 918-254-9583
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Provider Business Mailing Address
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Address Line | 8921 S MINGO RD
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City | TULSA
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State | OK
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Zip | 74133
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Country | US
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Telephone | 918-252-8060
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Fax | 918-254-9583
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2112
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License Number State | OK
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