Provider Demographics
NPI:1710864038
Name:PECK, KAMAILE ELIZABETH
Entity type:Individual
Prefix:
First Name:KAMAILE
Middle Name:ELIZABETH
Last Name:PECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAMAILE
Other - Middle Name:ELIZABETH
Other - Last Name:CONANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7194 CANYON SKY TRL
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9601
Mailing Address - Country:US
Mailing Address - Phone:720-431-8912
Mailing Address - Fax:
Practice Address - Street 1:11300 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33161-6628
Practice Address - Country:US
Practice Address - Phone:305-899-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant