MEDICARE: NICHOLE KAY PEANASKY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	SP012819	PA
2	363LA2200X	Adult Health Nurse Practitioner	RN214615	GA

General Provider Information

NPI Number	:	1578998878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE KAY PEANASKY

Provider Business Mailing Address
First Line	:	2665 N DECATUR RD STE 520
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6146
Country	:	US
Telephone Number	:	404-299-2223
Fax Number	:	404-297-5003

Provider Business Practice Location Address
First Line	:	2665 N DECATUR RD STE 520
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6146
Country	:	US
Telephone Number	:	404-299-2223
Fax Number	:	404-297-5003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	12/02/2025

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Directions to “ NICHOLE KAY PEANASKY ” Practice Location

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