Provider Demographics
NPI:1841593381
Name:PEEK, THERESA KAYE (APRN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KAYE
Last Name:PEEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:KAYE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1079
Mailing Address - Country:US
Mailing Address - Phone:270-827-0353
Mailing Address - Fax:270-827-4966
Practice Address - Street 1:1284 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6236
Practice Address - Country:US
Practice Address - Phone:270-389-2323
Practice Address - Fax:270-389-0526
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1100233163W00000X
KY3006685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000745187OtherANTHEM
KY7100184940Medicaid
KY000000745187OtherANTHEM