Provider Demographics
NPI:1427776509
Name:PEACOCK, ANNA ADELE (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ADELE
Last Name:PEACOCK
Suffix:
Gender:
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7853 S UNION AVE APT 2117
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2765
Mailing Address - Country:US
Mailing Address - Phone:405-593-5162
Mailing Address - Fax:
Practice Address - Street 1:2929 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5101
Practice Address - Country:US
Practice Address - Phone:918-665-1520
Practice Address - Fax:918-663-8435
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant