Provider Demographics
NPI:1801219670
Name:PECK, KARA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:PECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:NICOLE
Other - Last Name:HARTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1354
Mailing Address - Country:US
Mailing Address - Phone:212-385-3700
Mailing Address - Fax:
Practice Address - Street 1:214 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:724-385-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9107365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical