Jessica Anne Peacock, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704248068 Issued in MI

Practice address

829 N Center Ave Ste 130
Gaylord, MI 49735-1684

Phone

(989) 731-7930

NPI assigned

Oct 1, 2018

Sex

Female

Sole proprietor

No

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

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Munson Healthcare Otsego Memorial Hospital

  • Rural Health Clinic/Center
  • Gaylord, MI
  • NPI 1164628426
  Medicare reassignment NPD
• Munson Healthcare Otsego Memorial Hospital

  • Plastic Surgery Physician
  • Petoskey, MI
  • NPI 1770374530
  NPD
• Munson Healthcare Otsego Memorial Hospital

  • General Practice Physician
  • Gaylord, MI
  • NPI 1821064643
  NPD
• Munson Healthcare Otsego Memorial Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Gaylord, MI
  • NPI 1376657239
  NPD (past)
• Munson Healthcare Otsego Memorial Hospital

  • Anesthesiology Physician
  • Gaylord, MI
  • NPI 1518982073
  NPD (past)
• Southside Pediatrics PC

  • Pediatrics Physician
  • Hastings, MI
  • NPI 1912252909
  NPD (past)

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1952886400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 W STUTSMANVILLE RD",
            "city": "HARBOR SPRINGS",
            "state": "MI",
            "postal_code": "497409656",
            "telephone_number": "269-908-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE STE 130",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351684",
            "telephone_number": "989-731-7930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Grayling",
            "state": "MI",
            "postal_code": "497387074",
            "country_code": "US",
            "telephone_number": "989-348-0550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "825 N Center Ave",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351592",
            "country_code": "US",
            "telephone_number": "989-731-2100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14719 W Upright St",
            "address_purpose": "LOCATION",
            "city": "Charlevoix",
            "state": "MI",
            "postal_code": "497201949",
            "country_code": "US",
            "telephone_number": "231-547-3840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3860 S Straits Hwy",
            "address_purpose": "LOCATION",
            "city": "Indian River",
            "state": "MI",
            "postal_code": "497495146",
            "country_code": "US",
            "telephone_number": "231-238-0581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEACOCK",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704248068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha Carolin Pardo, FNP-C
• Patricia Duley MDPC
• Kathleen Marie Pawlanta, F.N.P.
• Alexis Payne, MD
• Dan Payne, PTA
• Mary Ann Pearall, RD
• Cathryn Gerian Pearl, PA-C
• Bailey Elise Pearson, OD
• Seth Pelkie
• Ethan Pennywitt, PHARMD

• Pediatric Nurse Practitioner in Gaylord, MI
• Providers in Gaylord, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.