Kimberly R Peckham, FNP, NPP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

400892 Issued in NY

Practice address

2646 W State St
Olean, NY 14760-1866

Phone

(716) 372-9344

Fax

(716) 372-9497

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1174554430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 W STATE ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147601866",
            "telephone_number": "716-372-9344",
            "fax_number": "716-372-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2646 W STATE ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147601866",
            "telephone_number": "716-372-9344",
            "fax_number": "716-372-9497"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4612 Millennium Dr",
            "address_purpose": "LOCATION",
            "city": "Geneseo",
            "state": "NY",
            "postal_code": "144541197",
            "country_code": "US",
            "telephone_number": "585-443-2018",
            "fax_number": "585-991-5013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "FNP, NPP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "332683",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "400892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02011163",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Om Parkash
• Katherine Grace Parnell, RD
• Vicki Elizabeth Pascucci
• Vincent Edward Pascucci, LCSW
• Rajnikant M Patel, MD
• Laura A Pecorella, RPA-C
• Natalie Pelton
• Kaelyn Joy Pemberton, COTA
• Jennifer L Penski-Adams, MSPT
• Jessica Perkins

• Psychiatric/Mental Health Nurse Practitioner in Olean, NY
• Providers in Olean, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.