Kurt Michael Peacock, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R30073 Issued in ND

Practice address

1015 S Broadway Ste 18
Minot, ND 58701-4667

Phone

(701) 857-8500

Fax

(701) 857-8555

NPI assigned

Oct 6, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699862375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S BROADWAY STE 18",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014667",
            "telephone_number": "701-857-8500",
            "fax_number": "701-857-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S BROADWAY STE 18",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587014667",
            "telephone_number": "701-857-8500",
            "fax_number": "701-857-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "KURT",
        "middle_name": "MICHAEL",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ND",
            "license": "R30073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54517",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne Lovell Patten Sr.
• Christina A Patterson
• Alicia Brianne Paulson
• Sheryll Diane Paulson
• Jordyn Peacock, PHYSICIAN ASSISTANT
• Pearson Chiropractic, PLLC
• Devanni Lynne Pearson, D.C.
• James Brian Pearson
• Paul Pearson, D.C.
• Christa Pecoraro

• All providers in Minot, ND
• Registered Nurse in North Dakota

• 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.