Cristal Kaye Peacock, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LPN075613 Issued in GA

Practice address

2121A Bellevue Rd
Dublin, GA 31021-2998

Phone

(478) 275-6813

Fax

(478) 274-7628

NPI assigned

Apr 26, 2012

Last updated

Apr 26, 2012By the provider in NPPES

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

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": "1335398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1336407469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121A BELLEVUE RD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212998",
            "telephone_number": "478-275-6813",
            "fax_number": "478-274-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121A BELLEVUE RD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212998",
            "telephone_number": "478-275-6813",
            "fax_number": "478-274-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "CRISTAL",
        "middle_name": "KAYE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-26",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN075613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Dublin, GA
• Providers in Dublin, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; 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.