Active NPI
Kristen Ann Peckham, BSN
- Registered Nurse
- Herkimer, NY
National Provider Identifier
1376828368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 22 523143
- Practice address
- 205 N Main St
Herkimer, NY 13350-1918 - Phone
- (315) 866-7630
- Fax
- (315) 866-0193
- NPI assigned
- Oct 21, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 22 523143 | NY | Primary |
Addresses
Primary practice location
205 N Main St
Herkimer, NY 13350-1918
Mailing address
1400 Noyes St
Utica, NY 13502-3854
Phone (315) 738-3800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 523143 | Other | NY | NYS EDUCATION DEPARTMENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22 523143 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321920000000",
"number": "1376828368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 NOYES ST",
"city": "UTICA",
"state": "NY",
"postal_code": "135023854",
"telephone_number": "315-738-3800",
"fax_number": "315-738-4451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 N MAIN ST",
"city": "HERKIMER",
"state": "NY",
"postal_code": "133501918",
"telephone_number": "315-866-7630",
"fax_number": "315-866-0193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECKHAM",
"first_name": "KRISTEN",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "BSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-21",
"last_updated": "2011-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "22 523143",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS EDUCATION DEPARTMENT",
"identifier": "22 523143",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Herkimer, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.