Provider Demographics
NPI:1881371045
Name:PEACOCK, RACHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 GLADE CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5136
Mailing Address - Country:US
Mailing Address - Phone:678-451-5739
Mailing Address - Fax:
Practice Address - Street 1:2603 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8256
Practice Address - Country:US
Practice Address - Phone:704-873-6515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13376363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-13376OtherNORTH CAROLINA MEDICAL BOARD
1206698OtherNCCPA