Tina Peck, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-77614 Issued in KS

Practice address

430 S Commerce St Ste 300
Wichita, KS 67202-4600

Phone

(316) 708-4099

Fax

(949) 209-5494

NPI assigned

Oct 21, 2020

Sex

Female

Sole proprietor

Yes

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

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Signify Health Medical Associates of Kansas LLC

  • Multi-Specialty Clinic/Center
  • Wichita, KS
  • NPI 1780261701
  Medicare reassignment NPD
• Hope Medical Forensic Services, LLC

  • Family Nurse Practitioner
  • Wichita, KS
  • NPI 1558948695
  NPD Authorized official

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1275132136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2250 N ROCK RD # 118-266",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672262331",
            "telephone_number": "316-708-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 S COMMERCE ST STE 300",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672024600",
            "telephone_number": "316-708-4099",
            "fax_number": "949-209-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "TINA",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-77614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Pearson
• Mary Rachel Pearson, LCMFT
• Sidney Pearson
• Kara L Peavey- McDonough, MA, CCC-SLP
• Viviana Pechin, PTA
• Madison Peckham, CRNA
• Michelle Diane Peckham, LCPC
• Carly Peckman
• Rachel Elizabeth Pecora, PHARM.D.
• Brian Pederson, RPH

• Family Nurse Practitioner in Wichita, KS
• Providers in Wichita, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.