Individual
KIMBERLY R PECKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, NPP
Contact information
Practice address
2646 W STATE ST, OLEAN, NY 14760-1866
(716) 372-9344
(716) 372-9497
Mailing address
2646 W STATE ST, OLEAN, NY 14760-1866
(716) 372-9344
(716) 372-9497
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
332683
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
400892
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02011163
—
NY
Enumeration date
07/05/2006
Last updated
11/12/2025
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