MEDICARE: MRS. BRITTANY ALESE PETERSON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	662870	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8N8485	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1114975315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITTANY ALESE PETERSON FNP-C

Provider Business Mailing Address
First Line	:	2201 MAIN STREET SUITE 214
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201
Country	:	US
Telephone Number	:	972-349-9211
Fax Number	:	972-349-9255

Provider Business Practice Location Address
First Line	:	2201 MAIN STREET SUITE 214
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201
Country	:	US
Telephone Number	:	972-349-9211
Fax Number	:	972-349-9255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/07/2022

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