Provider Demographics
NPI:1316350036
Name:KASSIE PECK, PLLC
Entity type:Organization
Organization Name:KASSIE PECK, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASSIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:918-404-1535
Mailing Address - Street 1:2033 W HOUSTON STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:405-537-9101
Mailing Address - Fax:918-512-4823
Practice Address - Street 1:2033 W. HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:405-537-9101
Practice Address - Fax:918-512-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty