Provider Demographics
NPI:1841803483
Name:PECKS, ALICHIA LASHAWN (FNP)
Entity Type:Individual
Prefix:
First Name:ALICHIA
Middle Name:LASHAWN
Last Name:PECKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-2981
Mailing Address - Country:US
Mailing Address - Phone:334-538-0866
Mailing Address - Fax:
Practice Address - Street 1:76 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-2981
Practice Address - Country:US
Practice Address - Phone:334-538-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139340363LF0000X
ALF04200184364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology