Provider Demographics
NPI:1578893392
Name:PEKIN, KIM (CPM, CNM)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PEKIN
Suffix:
Gender:F
Credentials:CPM, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17232 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3100
Mailing Address - Country:US
Mailing Address - Phone:240-422-3889
Mailing Address - Fax:
Practice Address - Street 1:17232 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3100
Practice Address - Country:US
Practice Address - Phone:240-422-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
VA0129000052176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife