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General NPI Number Information
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NPI Number | 1861454126
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Entity Type | Individual
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Provider Name | KERRIE PEACOCK-PRESTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 515 W 6TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-4324
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Country | US
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Telephone | 904-253-1639
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Fax |
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Provider Business Mailing Address
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Address Line | 921 NORTH DAVIS ST BUILDING A, SUITE 251
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-253-1639
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103213
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License Number State | FL
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