Provider Demographics
NPI:1396829412
Name:PEACHEY, KAREN ANN (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:PEACHEY
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 1:7115 N DIVISION ST
Mailing Address - Street 2:STE B349
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6507
Mailing Address - Country:US
Mailing Address - Phone:509-464-1600
Mailing Address - Fax:509-343-9391
Practice Address - Street 1:6025 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-7674
Practice Address - Country:US
Practice Address - Phone:509-464-1600
Practice Address - Fax:509-343-9391
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60070810363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016357Medicaid