Kelly Teresa Peck, NP-C

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95022984 Issued in CA

Practice address

36921 Cook St Ste 102
Palm Desert, CA 92211-6070

Phone

(760) 836-9066

NPI assigned

Oct 24, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1235856071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2193 E DEL LAGO RD",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922622511",
            "telephone_number": "805-746-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36921 COOK ST STE 102",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922116070",
            "telephone_number": "760-836-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "KELLY",
        "middle_name": "TERESA",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95022984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soniya Patidar, DMD
• Patricia L. James, M.D. , Inc.
• Monica Paz, HIGH SCHOOL DIPLOMA
• Pearle Visioncare, Inc
• Gerald Stuart Pease, DC
• Olivia Peck, AA
• Barbara Pedalino, PSY.D
• Joceline Alejandra Pedraza
• Brian J Peiper, RPH
• Autumn Pendleton

• Primary Care Nurse Practitioner in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.