Kathleen Marie Peck, PHN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

153753 Issued in CA

Practice address

11670 Atwood Rd
Auburn, CA 95603-9522

Phone

(530) 887-2800

Fax

(530) 887-2202

NPI assigned

May 14, 2007

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

Other names 1

• Ms. Kathleen Stanton Peck Other name

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275749863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 OAKHAVEN RD",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956034029",
            "telephone_number": "530-888-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11670 ATWOOD RD",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956039522",
            "telephone_number": "530-887-2800",
            "fax_number": "530-887-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CA",
            "license": "153753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "PECK",
            "middle_name": "STANTON",
            "prefix": "MS.",
            "credential": "PHN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dinesh P Patel, DDS
• Frances Lorelie Patmon, PHD, FNP-C
• Patricia Eley, L.E., Cpe
• Kaitlin Patrick
• Jack Alan Pearson, MD
• Farnoush Pedrami
• Todd Perbetsky, CSC 1
• Elena Kamakanikailialoha Pereira Da Silva
• Mary Patricia Perez, MFT
• Janet Perrone, LCSW

• Administrator Registered Nurse in Auburn, CA
• Providers in Auburn, CA by specialty
• Administrator Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.