KIMBERLY R PECKHAM FNP NPP NPI 1174554430

NPI Information

  • NPI: 1174554430
  • Provider Name: KIMBERLY R PECKHAM, FNP, NPP
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2646 W STATE ST
    OLEAN, NY
    ZIP 14760
  • Phone: (716) 372-9344

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NPI Details

Kimberly R Peckham, FNP, NPP is a psychiatric/mental health nurse practitioner in Olean, NY. Kimberly R Peckham, FNP, NPP NPI is 1174554430. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2646 W STATE ST
OLEAN, NY
ZIP 14760-866
Phone: (716) 372-9344
Fax: (716) 372-9497

The NPI 1174554430 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/5/2006 and was last updated on 11/12/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist332683NEW YORKNo
2363LP0808XNurse PractitionerPsychiatric/Mental Health400892NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
102011163MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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