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General NPI Number Information
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NPI Number | 1851755680
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Entity Type | Individual
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Provider Name | SARA LAUREN PEACOCK MS, RD, LD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 411 OAK ST ATTN: CREDENTIALS
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City | CINCINNATI
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State | OH
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Zip | 45219-2504
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Country | US
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Telephone | 513-984-1800
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Fax | 513-984-4909
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Provider Business Mailing Address
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Address Line | 1614 CELIA DR
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City | WICHITA FALLS
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State | TX
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Zip | 76302-4130
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Country | US
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Telephone | 601-720-3194
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1063048
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D1651
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License Number State | MS
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