Individual provider Active NPI

Kristin M Peck, PA-C

  • Medical Physician Assistant
  • Tulsa, OK
National Provider Identifier
1487924098
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2112 Issued in OK
Practice address
2488 E 81St St Ste 290
Tulsa, OK 74137-4299
Phone
(918) 494-2665
Fax
(918) 927-3201
NPI assigned
Jan 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2112 OK Primary
Medical Physician Assistant 363AM0700X OK

Addresses

Primary practice location

2488 E 81St St Ste 290
Tulsa, OK 74137-4299

Mailing address

2488 E 81St St Ste 290
Tulsa, OK 74137-4299
Phone (918) 494-2665

Other practice location 1

1945 Versailles St
Sarasota, FL 34239-6900
Phone (941) 367-0770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130628000105 TX Practitioner - Physician Assistant 5496995227 Reassigns benefits to 1 organization
I20250528000043 FL Practitioner - Physician Assistant 5496995227 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Weitzner Yonker and Kaine MD PAGroup PAC ID 3072598655, 16 clinicians
Cherokee NationGroup PAC ID 5799698742, 446 clinicians

Practice addresses (Care Compare)

1225 Jacaranda Blvd
Venice, FL 34292-4521
Phone 94136507701028

27371 S 4410 Rd
Vinita, OK 74301-7953
Phone (918) 256-4800

411 Commercial CT
Suite D
Venice, FL 34292-1650
Phone (941) 484-4409

Hospital & facility affiliations

  • Cherokee Nation W W Hastings Indian Hospital Hospital, Tahlequah, OK, CCN 370171
  • Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087
  • Sarasota Memorial Hospital - Venice Hospital, North Venice, FL, CCN 100359

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2112OKMDInternist Chiropractor

Interoperability endpoints

  • Direct secure messaging: peck.kristin.p1@direct.sarasotaarthritis.nextgenshare.com

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1326326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1487924098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2488 E 81ST ST STE 290",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741374299",
            "telephone_number": "918-494-2665",
            "fax_number": "918-927-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2488 E 81ST ST STE 290",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741374299",
            "telephone_number": "918-494-2665",
            "fax_number": "918-927-3201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1945 Versailles St",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342396900",
            "country_code": "US",
            "telephone_number": "941-367-0770",
            "fax_number": "833-974-1480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECK",
        "first_name": "KRISTIN",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-12",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "2112",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.