Provider Demographics
NPI:1184340127
Name:PECKHAM, JESSICA LOUISE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:PECKHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 STERLING CHAPEL WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9607
Mailing Address - Country:US
Mailing Address - Phone:919-805-1846
Mailing Address - Fax:
Practice Address - Street 1:4825 CREEKSTONE DR FL 4
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-0107
Practice Address - Country:US
Practice Address - Phone:919-613-9919
Practice Address - Fax:919-385-9279
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC238559163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care