MEDICARE: KRISTEN PETERSON APRN

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	363LF0000X	Family Nurse Practitioner	3012478	KY

General Provider Information

NPI Number	:	1831675651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN PETERSON APRN

Provider Business Mailing Address
First Line	:	325 W WALNUT ST STE 600
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1378
Country	:	US
Telephone Number	:	270-699-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 W WALNUT ST STE 600
Second Line	:
City	:	LEBANON
State	:	KY
Zip	:	40033-1378
Country	:	US
Telephone Number	:	270-699-9500
Fax Number	:

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

Provider Enumeration Date	:	07/15/2018
Last Update Date	:	07/15/2018

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Directions to “ KRISTEN PETERSON APRN” Practice Location

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