Healthcare Provider Details

I. General information

NPI: 1083918551
Provider Name (Legal Business Name): KRISTEN NOEL PETERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 E IRONWOOD SQUARE DR STE 110
SCOTTSDALE AZ
85258-4582
US

IV. Provider business mailing address

3507 E HAZELWOOD ST
PHOENIX AZ
85018-3435
US

V. Phone/Fax

Practice location:
  • Phone: 480-948-8400
  • Fax:
Mailing address:
  • Phone: 602-228-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3880
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: