Individual
KIERSTEN M PECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
900 CENTER PARK DR STE J, CHARLOTTE, NC 28217-2962
(704) 667-2544
Mailing address
1019 HOLLYHEDGE LN, INDIAN TRAIL, NC 28079-3639
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-3981
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UCR243M87479
BLUE CROSS BLUE SHIELD
NC
Enumeration date
08/23/2018
Last updated
08/23/2018
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