Provider Demographics
NPI:1134268808
Name:PECK, KAY LYNN (MPH RD CDE)
Entity type:Individual
Prefix:MRS
First Name:KAY
Middle Name:LYNN
Last Name:PECK
Suffix:
Gender:F
Credentials:MPH RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 GATEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6901
Mailing Address - Country:US
Mailing Address - Phone:707-427-4623
Mailing Address - Fax:
Practice Address - Street 1:1550 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6901
Practice Address - Country:US
Practice Address - Phone:707-427-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered