Provider Demographics
NPI:1558192559
Name:PECKSKAMP, HOLLY ANN (CPM)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:PECKSKAMP
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 MILESDALE CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4127
Mailing Address - Country:US
Mailing Address - Phone:508-789-7718
Mailing Address - Fax:
Practice Address - Street 1:4415 MILESDALE CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4127
Practice Address - Country:US
Practice Address - Phone:508-789-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife