Healthcare Provider Details

I. General information

NPI: 1487014338
Provider Name (Legal Business Name): KERRY ANN PETERSON PHD, DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13120 E 19TH AVE # C288-5
AURORA CO
80045-2567
US

IV. Provider business mailing address

13120 E 19TH AVE # C288-5
AURORA CO
80045-2567
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1362
  • Fax:
Mailing address:
  • Phone: 303-724-1362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0990196-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: