Provider Demographics
NPI:1245866425
Name:PEAK, DAWN DANETTE (APRN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DANETTE
Last Name:PEAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GABRIELLA CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-6574
Mailing Address - Country:US
Mailing Address - Phone:757-574-2426
Mailing Address - Fax:
Practice Address - Street 1:340 THOMAS MORE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5117
Practice Address - Country:US
Practice Address - Phone:859-957-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty