Provider Demographics
NPI:1083756472
Name:PEEK, CHARIS W (NP)
Entity Type:Individual
Prefix:MS
First Name:CHARIS
Middle Name:W
Last Name:PEEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 COUNTY ROAD 668
Mailing Address - Street 2:
Mailing Address - City:PISGAH
Mailing Address - State:AL
Mailing Address - Zip Code:35765-7170
Mailing Address - Country:US
Mailing Address - Phone:256-657-4370
Mailing Address - Fax:
Practice Address - Street 1:2207 MOODY RIDGE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4113
Practice Address - Country:US
Practice Address - Phone:256-259-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN
PENDINGMedicare ID - Type Unspecified