Provider Demographics
NPI:1932505146
Name:PEAK FAMILY PRACTICE (NP TO YOUR DOOR LLC)
Entity Type:Organization
Organization Name:PEAK FAMILY PRACTICE (NP TO YOUR DOOR LLC)
Other - Org Name:PEAK FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:719-465-2388
Mailing Address - Street 1:1304 N ACADEMY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3318
Mailing Address - Country:US
Mailing Address - Phone:719-465-2388
Mailing Address - Fax:888-975-4491
Practice Address - Street 1:1304 N ACADEMY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-465-2388
Practice Address - Fax:719-465-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-16
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26781239Medicaid
COA107997Medicare PIN
CO73289574Medicaid