Individual
MRS. KACIE MARIE PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4440 HIGHWAY 5, PLUMMER, ID 83851-9681
(559) 859-3168
Mailing address
4440 HIGHWAY 5, PLUMMER, ID 83851-9681
(559) 859-3168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
69205
ID
163W00000X
Registered Nurse
758195
CA
163W00000X
Registered Nurse
RN61343748
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
758195
NA
CA
Enumeration date
02/28/2023
Last updated
02/28/2023
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