Provider Demographics
NPI:1457223463
Name:PEEK, MYKEYAH ANGEL
Entity type:Individual
Prefix:
First Name:MYKEYAH
Middle Name:ANGEL
Last Name:PEEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4791 CRINKLEPOINT CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-3984
Mailing Address - Country:US
Mailing Address - Phone:404-901-5911
Mailing Address - Fax:
Practice Address - Street 1:4791 CRINKLEPOINT CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-3984
Practice Address - Country:US
Practice Address - Phone:404-901-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN710250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse