Provider Demographics
NPI:1790105971
Name:PECKHAM, JESSICA (RN, FNP-C, OCN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:RN, FNP-C, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HERITAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7800
Mailing Address - Country:US
Mailing Address - Phone:805-296-7819
Mailing Address - Fax:805-239-1278
Practice Address - Street 1:2130 HERITAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7800
Practice Address - Country:US
Practice Address - Phone:805-296-7819
Practice Address - Fax:805-239-1278
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily