Individual provider Active NPI

Molly Marie Peck

  • Acute Care Nurse Practitioner
  • Covington, LA
National Provider Identifier
1548849680
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
219190 Issued in LA
Practice address
1202 S Tyler St
Covington, LA 70433-2330
Phone
(985) 898-4000
NPI assigned
Apr 6, 2021
Last updated
Apr 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 219190 LA
Acute Care Nurse Practitioner 363LA2100X 219190 LA Primary

Addresses

Primary practice location

1202 S Tyler St
Covington, LA 70433-2330

Mailing address

409 Brown Thrasher Loop S
Madisonville, LA 70447-3046
Phone (985) 750-1973

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20210421000332 LA Practitioner - Nurse Practitioner 2668880287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1203 S Tyler St
200 Northlake Pulmonary Assoc at S
Covington, LA 70433-2353
Phone (985) 892-9143

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
219190LAMDCritical Care Medicine Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Tammany Parish Hospital Service District No 1 CurrentSince Apr 1, 2021 Accepting new patients
St. Tammany Parish Hospital Service District No 1 Current Accepting new patients
St Tammany Parish Hospital Service District No 1 CurrentSince Apr 1, 2021 Accepting new patients

Locations

1202 S Tyler St
Covington, LA 70433
Phone (985) 898-3743

1203 S Tyler St
Ste 200
Covington, LA 70433
Phone (985) 892-9143

606 W 11th Ave
#A
Covington, LA 70433
Phone (985) 892-3766

1006 S Harrison St
Covington, LA 70433
Phone (985) 845-9000

Organizations & group practices 3

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

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": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1548849680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 BROWN THRASHER LOOP S",
            "city": "MADISONVILLE",
            "state": "LA",
            "postal_code": "704473046",
            "telephone_number": "985-750-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 S TYLER ST",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704332330",
            "telephone_number": "985-898-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "MOLLY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-06",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "LA",
            "license": "219190",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "219190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.