Provider Demographics
NPI:1467142679
Name:PECK, BAILEY (PA, RD)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:PA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4307
Mailing Address - Country:US
Mailing Address - Phone:913-708-5868
Mailing Address - Fax:
Practice Address - Street 1:4820 W 76TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4307
Practice Address - Country:US
Practice Address - Phone:913-708-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant