Individual
KIMBERLY L PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4280 N VALDOSTA RD, VALDOSTA, GA 31602-6814
(229) 671-2066
Mailing address
PO BOX 8846, GREENSBORO, NC 27419-0846
(336) 553-1659
(336) 553-3994
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
127617
MO
367500000X
Certified Registered Nurse Anesthetist
RN193082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141532701
—
AR
01
—
175118
MO BLUE SHIELD
MO
05
—
233419908A
—
GA
05
—
233419908B
—
GA
05
—
233419908C
—
GA
05
—
915080105
—
MO
01
—
98727
ARK BLUE SHIELD
AR
Enumeration date
01/31/2007
Last updated
06/28/2023
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