Kacie Marie Peacock, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

69205 Issued in ID

Practice address

4440 Highway 5
Plummer, ID 83851-9681

Phone

(559) 859-3168

NPI assigned

Feb 28, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1083313159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 HIGHWAY 5",
            "city": "PLUMMER",
            "state": "ID",
            "postal_code": "838519681",
            "telephone_number": "559-859-3168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 HIGHWAY 5",
            "city": "PLUMMER",
            "state": "ID",
            "postal_code": "838519681",
            "telephone_number": "559-859-3168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "KACIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-28",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN61343748",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "758195",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "69205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NA",
            "identifier": "758195",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connie Michelle Nelson, RN
• David J Ochoa, RADIOGRAPHER REG EL
• Maggie A Olson, MLT
• Michele L Ott
• Carla Rae Patterson, RD
• Anthony Lee Peterson, PHARMD.
• Plummer Gateway Fire Protection
• Plummer Worley School District #44
• Raymond Joseph Prevost, LMSW
• Carl Printz, LMSW

• Registered Nurse in Plummer, ID
• Providers in Plummer, ID by specialty
• Registered Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.