Healthcare Provider Details

I. General information

NPI: 1982536421
Provider Name (Legal Business Name): KYLEE RUTH PETERS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 SW 130TH TER
DUNNELLON FL
34432-3496
US

IV. Provider business mailing address

8435 SW 130TH TER
DUNNELLON FL
34432-3496
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-6416
  • Fax:
Mailing address:
  • Phone: 702-960-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN11047838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: